Ergonomics Resource Center
Find information, advice and tools for preventing nurse stress and musculoskeletal injury
Nurse Injury Data
1Occupational injuries and illnesses among registered nurses. U.S. Bureau of Labor Statistics, 2018 (based on 2016 data)
2Safe Patient Handling and Mobility. Association of Rehabilitation Nurses
3Injury Facts©, National Safety Council, 2016-17 data
4Worker Safety in Your Hospital. OSHA, 2011
Musculoskeletal injuries: Not just from moving patients
Because the majority of nurse injuries are suffered while moving patients, injuries related to computer/EHR ergonomics are often overlooked. But:
As a consequence of the poor ergonomic design of nursing computer workstations this research found that 32% of nurses using a computer reported an upper extremity musculoskeletal disorder (UEMSD) and 60% of these UEMSDs were carpal tunnel syndrome cases, and poor workstation design requiring frequent awkward postures was identified as the major risk factor.1
As nurses spend more and more time on the computer at the point of care, workstation ergonomics become increasingly important for improving nurse health, safety, productivity and overall well-being – and for reducing a significant cost associated with EHR.
1Ergonomics Concerns and the Impact of Healthcare information technology. International Journal of Industrial Ergonomics, July 2011
- Set the top of the monitor at eye level, and angle the bottom of monitor 10-15 degrees toward the nurse. The display resolution should enable easy reading without bending the neck.
- When typing, keep forearms parallel to the ground and wrists neutral (not flexed or extended). Worksurface height adjustment is the primary means of achieving this position, but a negative keyboard tilt (slightly upward toward the user) helps encourage the proper wrist posture.
- If possible, the mouse pad should be raised approx. 1 inch above keyboard to prevent excess shoulder abduction or flexion. Learn more.
- When seated, thighs should be parallel to ground. The backs of the knees should be about two inches from the edge of the seat.
- The user’s back should be straight. When seated, use a pillow or pad to support lower lumbar if needed.
- Use an external keyboard and mouse whenever practical. These accessories enable healthier postures during data entry and EHR application use.
- Recline the laptop display as needed to enable a straight-on screen viewing angle.
- Consider using the laptop as the computer in an LCD cart – particularly if the main goal is to leverage your existing laptop investment (as opposed to supporting a laptop-specific workflow).
- Change positions often during the day to prevent prolonged poor postures.
- Reserve laptop workstations for periodic use, and deploy LCD workstations for steadier use.
Pro Tip: Push, Don’t Pull
- Lighter starting weight (weight of base model cart). The lower the starting weight, the more flexibility you’ll have to add equipment and accessories without exceeding your overall weight limit.
- Lighter total weight (weight of fully equipped cart).
- Balanced weight distribution. Ideally the cart’s weight should be distributed evenly over the wheels, to minimize the effort required to move, turn and stop the cart. Learn more
Pro Tip: Weight Matters Most
All other things being equal, a heavier cart requires more effort to roll, turn and stop – and nurses have to exert that extra effort hundreds of times during every shift. Always strive for the lightest practical cart for any given workflow. Be wary of supposed ergonomic features that add significant weight to the cart.
Pro Tip: Test Adjustment Carefully
- Full sit-to-stand height adjustment without pre-defined ‘stops’ (nurses should be able to choose any height between the maximum and minimum).
- Ease of adjustment. Any nurse should be able to raise or lower the worksurface with minimal effort and without strain. And they should easily be able to lower the cart while moving, for improved visibility and safety.
- Optimal body mechanics. Nurses shouldn’t have to extend their arms far from their bodies to operate the height adjustment.
- Silent operation. Height adjustment should never wake or disturb patients. (Most nurses would rather work in discomfort than wake a patient.)
Keyboard/mouse tray adjustment
- Positive/negative tilt. Ergonomics experts recommend a negative tilt – a tilt down and away from the user – to maintain a proper and more comfortable wrist posture while typing.
- Easy to adjust, but firm – with no bouncing. The keyboard should remain firmly in position once adjusted and should not bounce during typing.
- Retractable if necessary. If front-opening storage drawers are used, keyboard should retract to simplify drawer access.
Pro Tip: Raise the Mouse Tray
Pro Tip: Big Screen Support
Make sure that any adjustable mount you choose can support the size and the weight of the LCD you plan to use. (Today most EHR vendors recommend a 24″ flatscreen LCD, which typically weighs 6 to 10 lbs.) If you plan to use your cart for telehealth, add the weight of a high-definition video camera (which typically mounts to the top of the LCD).
- Tilt range. The monitor should be able to tilt back at least 20 degrees to enable a proper viewing angle while standing or sitting.
- Forward/back adjustment for optimal viewing comfort and focus.
- Easy movement but firm positioning. Adjustments in any direction should require minimal effort, but should maintain their position once made.
- Height adjustable if necessary to make it easier to properly position the monitor height relative to eye level.
Mobility and maneuverability
- The cart should roll with minimal resistance on tile, wood and any other hard flooring surface in the hospital. Choose single- or dual-wheel casters as required.
- The cart should roll quietly and the cart structure should not shake or rattle.
- All four casters should pivot for maximum maneuverability and minimal resistance.
Pro Tip: Optional Motion Control
For heavier carts – e.g,, carts equipped with multiple drawers, printer shelves, etc. – consider an optional motion or steering control system that helps keep the cart from ‘drifting’ and enables sharp, controlled turns in tight spaces. Center-wheel guidance systems provide the tightest possible turning radius and maximum directional control with the least effort.
Pro Tip: Keep a Low Profile at the Bedside
Look for a low-profile cart base that can slide easily under patient beds, enabling nurses to get close to the bedside (and to tuck the cart out of the way when not in use). And look for a compact footprint to helps nurses maneuver with less effort in crowded hallways and patient rooms.
Options and Accessories
- Easy-to-reach tools. Scanners, printers and other frequently-used tools should be mounted so that nurses can reach them without stretching, bending or walking around the cart.
- Easy-to-use storage. Nurses should be able to open storage drawers and view and access drawer contents without awkward bending – even in tight spaces – and ideally without changing their position relative to the cart, so they don’t ‘lose their place’ on the EHR screen.