Why Do Nurses CNAs EMTs and Other Healthcare Workers Suffer So Many Job Injuries?

Why Do Nurses CNAs EMTs and Other Healthcare Workers Suffer So Many Job Injuries?

Healthcare workers spend their careers caring for people who are sick, injured, disabled, or unable to care for themselves. But the physical demands of providing that care can place healthcare employees at significant risk of suffering serious injuries themselves.

Consider a certified nursing assistant (CNA) helping a patient move from a bed into a wheelchair. The patient begins to fall. The CNA instinctively tries to prevent the fall and feels a sharp pain in her lower back.

Or consider a registered nurse attempting to reposition a patient who cannot assist with the movement. The nurse suffers a shoulder injury that eventually requires surgery.

An emergency medical technician (EMT) may injure his back while lifting a stretcher, suffer an injury when an ambulance crashes, or be assaulted while responding to an emergency.

Patient lifting, repetitive physical activity, workplace violence, and emergency response make healthcare a physically demanding and sometimes dangerous occupation.

For Alabama healthcare employees, these injuries can also raise difficult questions about workers’ compensation, medical treatment, and the ability to return to work.

What Do Alabama Workplace Injury Statistics Tell Us About Healthcare Workers?

According to the U.S. Bureau of Labor Statistics (BLS), Alabama private-industry employers reported approximately 27,900 nonfatal workplace injuries and illnesses in 2024, an incidence rate of 1.9 cases per 100 full-time equivalent workers.

The combined education and health services sector reported a higher rate of 2.9 cases per 100 full-time equivalent workers.

That sector accounted for approximately 5,800 reported injuries and illnesses, including 2,900 cases involving days away from work, job transfer, or restricted duties.

These figures combine education and health services and should not be interpreted as applying exclusively to nurses, CNAs, hospitals, or ambulance services. Nevertheless, they demonstrate the substantial occupational-injury burden in a sector employing many Alabama healthcare workers.

The physical demands of healthcare help explain why these injuries occur.

Why Are Nurses and CNAs at Risk for Back, Neck, and Shoulder Injuries?

One of the greatest occupational hazards in healthcare is manual patient handling.

Patients are not stationary objects that can always be lifted or moved in a controlled manner.

A patient may be unable to bear weight, lose balance unexpectedly, resist assistance, or require repositioning in a confined space.

Nurses and nursing assistants routinely transfer patients between beds and wheelchairs, assist with bathing and toileting, reposition patients in bed, and attempt to prevent falls.

These activities frequently require bending, twisting, reaching, or lifting while working in awkward positions.

The Occupational Safety and Health Administration (OSHA) identifies patient handling as a major source of musculoskeletal injuries among healthcare employees. OSHA’s historical data show that nursing assistants experienced particularly high rates of musculoskeletal disorders involving days away from work.

A particularly dangerous situation occurs when an employee attempts to prevent a patient from falling.  The employee may have only a moment to react, with no opportunity to obtain mechanical lifting equipment or assistance.

A single unexpected movement can produce a serious back, shoulder, neck, or knee injury.

Can Repeated Patient Lifting Cause a Workers’ Compensation Injury?

Yes, depending upon the medical and legal evidence.

Not every healthcare injury occurs during one dramatic incident. A nurse or CNA may repeatedly lift, turn, transfer, and reposition patients throughout a shift. Over time, these activities can place substantial stress on the back, shoulders, knees, and other parts of the body.

Some employees can identify a particular event when they felt immediate pain. Others describe symptoms that developed gradually; that distinction matters under Alabama workers’ compensation law.

Ala. Code § 25-5-81(c) requires an employee claiming an injury caused by gradual deterioration or cumulative physical stress to prove, by clear and convincing evidence, that the injury arose out of and occurred in the course of employment.

What Does Clear and Convincing Evidence Mean?

Clear and convincing evidence is a higher burden of proof than the ordinary preponderance-of-the-evidence standard applicable to most accidental-injury workers’ compensation claims.

The evidence must be strong enough to produce a firm conviction that the essential elements of the claim have been established and that the conclusion is highly probable.

For a nurse or CNA claiming a cumulative-trauma injury, the evidence should address both the physical demands of the employment and the medical relationship between those demands and the diagnosed condition.

Relevant evidence may include the frequency of patient lifting and transfers, the weights or assistance involved, the employee’s work history, the development of symptoms, medical records, and medical opinions concerning causation.

It is not enough merely to establish that an employee has a back, neck, shoulder, or knee condition and performs physically demanding work. The employee must establish the required causal connection between the employment and the injury.

What Did the Court Decide in Zeanah v. Stewart Animal Clinic?

In Zeanah v. Stewart Animal Clinic, P.C., 752 So. 2d 505 (Ala. Civ. App. 1999), a veterinary-office employee sought workers’ compensation benefits for several conditions, including knee problems she associated with her work duties.  The trial court rejected her claims, finding, among other things, insufficient evidence of an occupational disease or a compensable accident.

On appeal, the Alabama Court of Civil Appeals distinguished an occupational-disease claim from a claim based on gradual deterioration or cumulative physical stress.

The Court explained that an employee may pursue a cumulative-stress injury claim under § 25-5-81(c), even when the condition does not qualify as an occupational disease. However, the employee must satisfy the heightened clear-and-convincing-evidence requirement.  Because the trial court had not expressly evaluated the cumulative-stress theory under that standard, the appellate court reversed that portion of the judgment and remanded the case for the trial court to determine whether the employee had met her burden. Zeanah, 752 So. 2d at 509–10.

Importantly, the appellate court did not decide that the employee had proved a compensable cumulative-stress injury. It required the trial court to apply the proper legal standard.

For Alabama nurses and CNAs, the practical lesson is that repetitive patient handling can support a workers’ compensation claim, but the employee must present sufficiently persuasive evidence connecting the injury to the physical stresses of the job.

What If a Patient Assaults a Nurse, CNA, or Healthcare Employee?

Healthcare employees face risks that are not ordinarily associated with office work.

Patients may be confused, disoriented, intoxicated, experiencing a behavioral emergency, or otherwise unpredictable. Visitors can also become aggressive.

A nurse may be struck while providing treatment. A CNA may be pushed to the floor while assisting a patient. An EMT may be assaulted during an emergency response.

OSHA recognizes workplace violence as a significant occupational hazard in healthcare, particularly for employees who have direct contact with patients.

Under Alabama workers’ compensation law, the important question is generally whether the injury arose out of and occurred in the course of employment.  An assault connected to providing patient care may be compensable. However, the facts still matter, including whether the assault arose from the employment or from a purely personal dispute.

Why Are EMTs and Paramedics Exposed to Additional Occupational Hazards?

EMTs and paramedics share many of the physical hazards faced by nurses and CNAs, but their working environment introduces additional risks.

Emergency medical personnel may have to lift patients down stairways, move stretchers over uneven ground, carry equipment into confined spaces, or assist patients at roadside emergencies.

Unlike employees working inside a hospital, EMTs and paramedics often have little control over the environment in which treatment occurs.

Vehicle collisions are another major concern.  An ambulance crew member can be injured while responding to an emergency, transporting a patient, or traveling between assignments.

When another driver causes the collision, the injury may involve both workers’ compensation and a separate third-party personal-injury claim.

Recommended reading: Can I Have Both a Workers’ Compensation Claim and a Personal Injury Claim?

Can a Home-Health Nurse Receive Workers’ Compensation After a Car Wreck?

Often, yes, but the circumstances of the travel matter.

Consider a home-health nurse traveling between patient appointments or a hospice nurse whose job requires driving to patients’ homes throughout the day.  If the employee is injured while performing required work travel, the collision may be compensable under Alabama’s Workers’ Compensation Act.

A particularly relevant decision is Hospice Family Care v. Allen, 218 So. 3d 1222 (Ala. Civ. App. 2016).

What Happened in Hospice Family Care v. Allen?

Suzanne Sharp Allen was a registered nurse whose job required traveling to patients’ homes to provide hospice care.  Her responsibilities also included documenting patient visits, entering billing information, and communicating patient information to the next nursing shift.

The employer permitted nurses to perform those duties away from its office, including at home.

On February 3, 2014, Allen was traveling toward her home after visiting patients. She had stopped briefly at a pharmacy for a personal prescription and resumed her trip.

She was killed when another vehicle crossed into her lane.

The employer argued that the collision was not compensable because Allen was traveling home and had performed a personal errand.  The Court of Civil Appeals disagreed.

The evidence established that Allen remained responsible for work duties, had not completed her required documentation, and was traveling home where she routinely performed additional work. The Court also concluded that her brief pharmacy stop did not constitute a substantial deviation from her employment.

The Court affirmed the determination that the fatal collision arose out of and occurred in the course of her employment. Hospice Family Care v. Allen, 218 So. 3d 1222, 1228–30 (Ala. Civ. App. 2016).

Why Does This Case Matter to Healthcare Workers?

The decision illustrates why work-related travel cannot always be classified simply as commuting.

A nurse traveling between patient appointments may be performing an essential part of the job. Even travel toward home can present additional questions when the employer expects the employee to continue performing work duties there.

But Hospice Family Care does not mean that every accident involving a home-health employee is compensable.  The employee’s duties, the purpose of the trip, any personal deviation, and whether the employee was still performing the employer’s business remain important.

If a negligent third-party driver caused the collision, the employee may also have a separate personal-injury claim, subject to the applicable workers’ compensation reimbursement provisions under Ala. Code § 25-5-11.

Can Healthcare Workers Receive Workers’ Compensation for These Injuries?

In many cases, yes.

Under Ala. Code § 25-5-51, a covered injury generally must arise out of and occur in the course of employment.  A nurse injured while lifting a patient, a CNA hurt during a transfer, or an EMT injured while loading a stretcher may have a compensable claim.

Depending upon the circumstances, benefits may include authorized medical treatment, temporary disability payments, and permanent disability compensation.

Under Ala. Code § 25-5-77, the employer or workers’ compensation carrier generally controls the selection of the authorized treating physician, subject to the employee’s statutory rights concerning physician selection and disputes over treatment.

Healthcare employees should also report injuries promptly.

Ala. Code § 25-5-78 generally requires written notice within five days, subject to statutory exceptions, and establishes an outside 90-day notice requirement. Alabama decisions also recognize that an employer’s actual knowledge may satisfy the notice requirement in appropriate circumstances.

An employee should not assume that a work injury is insignificant merely because it initially appears to be a strain or sprain. Some injuries resolve with conservative treatment. Others require surgery or result in permanent physical restrictions.

Recommended reading: What Should I Do After a Car Accident While Working?

What If the Healthcare Worker Already Had Back or Neck Problems?

A preexisting condition does not automatically defeat an Alabama workers’ compensation claim.  This is particularly important in healthcare because employees may have years of physically demanding work behind them.

A nurse may have degenerative disc disease but have been performing regular nursing duties without significant restrictions before a lifting accident.  After the accident, the nurse may develop symptoms that prevent a return to those duties.

In Ex parte Lewis, 469 So. 2d 599, 601 (Ala. 1985), the Alabama Supreme Court recognized that when employment aggravates, accelerates, or combines with a latent condition to produce disability, the preexisting condition does not necessarily disqualify the workers’ compensation claim.

The Court also addressed the improper apportionment of disability attributable to a previously nondisabling condition.

The important questions include whether the employee could perform the job before the accident, what changed afterward, and what the medical evidence establishes about the relationship between the work injury and the resulting disability.

What If the Injured Nurse or CNA Cannot Return to Patient Care?

This may be the most important long-term issue in a serious healthcare injury claim.

A registered nurse may remain capable of performing many skilled nursing tasks but no longer be able to lift patients, assist with transfers, stand throughout a shift, or respond physically to emergencies.

A CNA may be unable to return to bedside care because of permanent lifting, bending, or standing restrictions.

The ability to return to work cannot always be determined simply by asking whether the employee can perform some of the duties associated with the occupation.

The more important question is whether the employee can perform the material physical duties of the job and, if not, what other employment the employee is realistically capable of performing.

Under Ala. Code § 25-5-57, the distinction between temporary disability, permanent partial disability, and permanent total disability can become critical.

The statute defines permanent total disability in terms of an injury or impairment that permanently and totally incapacitates the employee from working at and being retrained for gainful employment.

A permanent impairment rating may be relevant, but it does not necessarily resolve every question concerning vocational disability.

The analysis may also involve education, work history, transferable skills, physical restrictions, and the employee’s ability to obtain and perform reasonably gainful employment.

For example, a nurse with extensive administrative experience may have employment options different from those available to a CNA whose work history consists almost entirely of physically demanding patient care.

And permanent injuries involving scheduled members, such as certain arm or leg injuries, require additional statutory analysis before applying a general loss-of-earning-capacity approach.

Doctors evaluate medical impairment. Determining disability may also require examining the employee’s actual vocational circumstances.

Recommended reading: Can I Have a Workers’ Compensation Claim If I Had a Preexisting Condition?

Recommended reading: Why Restrictions Matter More Than Your Diagnosis-Permanent Restrictions

What If a Healthcare Worker Contracts an Illness Through Work?

Healthcare employees may also face occupational exposure to infectious diseases and other biological hazards; however, not every illness contracted by a healthcare employee is automatically compensable.

Alabama’s occupational disease provisions, including Ala. Code § 25-5-110, establish requirements concerning diseases arising from hazards associated with particular employment.

The employee must establish the legally required connection between the illness and the work.  The nature of the exposure, diagnosis, medical evidence, and whether the condition qualifies under the applicable statutory provisions can all matter.

An occupational disease claim therefore requires a different analysis from a straightforward traumatic lifting injury.

What Should an Injured Alabama Healthcare Worker Do?

A healthcare employee injured on the job should promptly report the incident and obtain appropriate medical attention.

The employee should accurately describe how the injury occurred, including the particular patient-handling task, lifting movement, assault, fall, vehicle collision, or other event involved.

Relevant evidence may include incident reports, witnesses, staffing records, patient-transfer procedures, equipment records, medical restrictions, and documentation of the employee’s actual job duties.

If the injury becomes permanent, it is particularly important to identify what physical duties the employee performed before the injury and which duties can no longer be performed.

Those facts may become central to the disability determination.

Recommended reading: Occupational Diseases and Alabama Workers Compensation Claims

Healthcare Workers Face Serious Occupational Risks—and Serious Questions After an Injury

Nurses, CNAs, EMTs, paramedics, and other healthcare employees perform work that is essential to Alabama communities, but patient handling, physically demanding shifts, workplace violence, emergency responses, and work-related travel expose many healthcare employees to substantial occupational hazards.

When an injury occurs, the resulting workers’ compensation claim may involve much more than paying the initial medical bill.  There may be disputes about medical causation, preexisting conditions, authorized treatment, permanent restrictions, and the employee’s ability to return to work.

A healthcare employee who can no longer perform the physical demands of patient care may face a significant loss of earning capacity, even when the employee retains valuable medical knowledge and experience.

Understanding those distinctions is essential to evaluating the claim.

Talk With an Alabama Workers’ Compensation Lawyer

If you are a nurse, CNA, EMT, paramedic, or other healthcare employee who has suffered a work-related injury, you may be entitled to benefits under Alabama’s Workers’ Compensation Act.

At Powell & Denny, P.C., we represent injured Alabama workers in disputes involving medical treatment, permanent physical restrictions, vocational disability, and workers’ compensation benefits.  We also assist clients when a serious work injury raises related questions about Social Security Disability benefits or a potential third-party personal-injury claim, so if you suffered a serious Alabama job injury, and have questions about your rights under Alabama’s retaliatory discharge law, don’t hesitate to contact and speak with one of the experienced Alabama Workers Compensation and Social Security Disability attorneys at Powell and Denny today for a free consultation. Appointments are available in person, or virtually via Zoom if more convenient.  Powell and Denny would appreciate the opportunity to help.  And remember, there is no fee unless you win.

Powell & Denny: We Work When You Can’t.

Recommended Reading: What Are the Most Dangerous Jobs in Alabama?