A resident needed to go the bathroom, which meant Margaret Boyce had to make a choice.

Boyce, a certified nursing assistant in a Middlesex County nursing home, needed help lifting the wheelchair-bound resident. But on that evening about four years ago, she said, the only other assistant on duty was too busy to help. She decided to move him on her own.

As she set the man down on the toilet, she said, she felt a “click” in her right shoulder. A burning sensation shot down her neck to her fingertips. She used her left hand to turn on a help light, but a nurse didn’t notice for at least 15 minutes.

Boyce said she ended up spending months recovering from a dislocated shoulder. She blamed short-staffing for her injury.

“Looking for help was impossible,” she said earlier this month, after an attempt by state lawmakers to pass bill to improve staffing floundered. (Boyce’s union, 1199 SEIU United Healthcare Workers, asked that Boyce’s facility not be named to protect her job.)

Tasked with lifting, cleaning and caring for often helpless patients, certified nursing assistants work in one of the most dangerous jobs in the country.

The job has a higher injury and illness rate than freight movers, construction laborers or carpenters, according to recent data from the U.S. Bureau of Labor Statistics.

Out of more than 900 occupations sorted by injury and illness rate, nursing assistants nationwide ranked 34. The risk can be especially acute in nursing homes. Throughout the country, nursing and residential care facilities reported higher rates of injuries and illnesses than the vast majority of other workplaces in 2018, the most recent year available.

Compounding the problem within nursing homes is that many places are chronically short staffed, which puts workers in an even riskier situation. In interviews with more than a dozen nursing home employees throughout the state, many repeatedly said the workers can be just as much a victim of staffing shortages as the residents.

The federal government rated a quarter of New Jersey’s nursing homes “below average” or “much below average” because of insufficient staffing, according to recent reports by the Centers for Medicare & Medicaid Services.

Ashley Conway, a nurse and assistant professor at the Rutgers School of Management and Labor Relations, said short-staffing does contribute to injuries. An immobile patient who needs to go to the bathroom, for example, puts nursing assistants especially in a tough spot if they do not have help.

“Do I do let them lay in their in beds and cry for help, or risk a back injury?” she said. "It’s a lose-lose situation.”

Conway, who has also advised the state’s labor department, estimated that many injuries are never even reported, and she doubted whether many employees received workers’ compensation. (A spokesman for New Jersey’s Department of Labor and Workforce Development said they did track workers’ compensation cases, but he declined to release specific records, citing privacy laws.)

Another bill meant to increase staffing levels has already been introduced this legislative session.

By the numbers

Statewide, there are 56,500 nursing assistants in hospitals and nursing homes alike.

Most New Jersey nursing homes are privately owned, and non-fatal injury rates for employees have declined in both the state and the country, according to federal data.

Yet more than 1,400 annual incidents continue to cost employees and employers.

Over the past eight years, more than 14,000 injuries and illnesses caused employees to miss at least one day of work at privately owned nursing and residential care facilities in New Jersey, a higher rate than the nation overall.

Many missed more. The state’s nursing assistants missed a median of six days of work in 2018, and New Jersey has reported some of the highest numbers of days missed when compared to other states throughout the decade.

Missing work can increase the strain on staff, creating a snowball effect. More than one employee recalled trying to call in sick because of exhaustion, and being pressured to show up anyway because of how few people were working.

Furthermore, showing up only earns nursing assistants an average of $14.61 an hour in New Jersey, less than what you can make as Whole Foods cheese buyer (where you’ll also face a considerably lower injury rate).

Dangerous work

Employees know that helping vulnerable people can endanger caretakers in even the best circumstances.

Nikki Hebron, a former nursing assistant, was with two colleagues at a nursing home in Cape May back in 2002 when she tried to help a tall resident into bed.

The man had a broken femur, she said, which ruled out using a machine to raise him up. As the three tried to lift him, the man’s knee buckled and he started to fall. Hebron “football tackled” him into the bed and herniated a disc in her back, she said. She now works as a clerk at the same nursing home because she’s no longer able to safely move people.

Hebron said that she felt like residents’ safety was sometimes prized above caregivers.

"It’s almost better that you get hurt than you let one of the residents get hurt,” Hebron said.

Confused residents can also threaten caretakers.

“We’re always in personal danger,” said Alicia Harvey, a licensed practical nurse at the Bergen New Bridge Medical Center’s long term care unit. “We’ve all been chased by patients, we’ve all been hit or kicked or spit on.”

She cautioned that hiring more people wasn’t a silver bullet, especially when it came to violent residents. “There needs to be some accountability for people who do abuse the nurses,” she said.

Donnalee Corrieri, a vice president at New Bridge, said they had seen a drop in workplace violence after making internal changes, including the establishment of a workplace violence prevention team.

Training staff how to handle potentially violent residents was crucial, she said, especially because New Bridge didn’t use restraints.

Growing demand

Theresa Edelstein, a vice-president for the New Jersey Hospital Association, agreed that training is crucial to helping employees avoid injuries.

“It’s a difficult job,” she said, “and an aging workforce contributes to the risk.”

She also said she was concerned that there will be enough workers to keep up with the growing demand.

The need for certified nursing assistants especially is only expected to increase as the 65-and-older population soars nationwide, from 47.8 million a few years ago to 88 million by 2050, according to the nonprofit research and advocacy organization LeadingAge.

More than two thirds of those people will require some form of long-term care or in-home support services, according to the U.S. Department of Health and Human Services.

Blake Nelson can be reached at bnelson@njadvancemedia.com. Follow him on Twitter at @BCunninghamN.

Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio.

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