Nursing Research March/April 2004 Vol 53, No 2 87 Factors Associated With Staff Injuries in Intermediate Care Facilities in British Columbia, Canada Annalee Yassi ▼ Marcy Cohen ▼ Yuri Cvitkovich ▼ Il Hyoek Park ▼ Pamela A. Ratner Aleck S. Ostry ▼ Judy Village ▼ Nancy Pollak  Background: Large variations in staff injury rates across inter- mediate care facilities suggest that injuries may be driven by facility-specific work environment factors.  Objectives: To identify work organization, psychosocial, and biomechanical factors associated with staff injuries in inter- mediate care facilities, to pinpoint management practices that may contribute to lower staff injuries, and to generate a provisional conceptual framework of work organization char- acteristics.  Methods: Four representative intermediate care facilities with high staff injury rates and four facilities with comparable low staff injury rates were selected from Workers’ Compensation Board (WCB) databases. Methods included on-site injury data collection and review of associated WCB data, ergonomic study of workloads, a telephone survey of resident care staff, manager-staff interviews, and focus groups.Pearson product- moment correlation coefficients identified associations between variables. Analysis of variance and t tests were used to determine differences between low and high staff injury rate facilities. Content analysis guided the qualitative analysis.  Results: There were no significant differences between low and high staff injury rate facilities in terms of workers’ characteris- tics, residents’ characteristics, and per capita public funding. The ergonomic study supported the survey data in demon- strating a relation among low staffing levels, greater muscle loading, and greater risk of injury. As compared with facilities that had high staff injury rates, facilities with low staff injury rates had significantly more favorable staffing levels and sup- portive work environments. Perceived quality of care was strongly correlated with burnout, health, and satisfaction.  Conclusions: Safer work environments are promoted by favor- able staffing levels, convenient access to mechanical lifts, workers’ perceptions of employer fairness, and management practices that support the caregiving role.  Key Words: nursing homes  organizational climate  organiza- tional culture  staff injury rates he international literature shows high staff injury rates in the healthcare sector (Koehoorn, Lowe, Ron- deau, Schellenberg, & Wagar, 2002; Yassi, Ostry, Spiegel, Walsh, & deBoer, 2002). Intermediate care (IC) facilities provide 24-hour nursing care for individuals who can no longer live safely in their homes yet still are somewhat mobile (Cohen et al., 2003). This population includes clients with advanced dementia or high and changeable needs related to activities of daily living (ADLs). Staff injury rates in IC facilities are as much as 50% higher than staff injury rates in the acute care sector. However, the Workers’ Compensation Board (WCB) of British Columbia (2000) 1995-1999 databases showed considerable varia- tion in injury rates within the IC sector. The lowest quar- tile 5-year injury rate for “good” performers was four times better than the corresponding rate for “poor” per- formers (WCB of British Columbia, 2000). T Annalee Yassi, MD, MSc, FRCPC, Founding Executive Director, Occupational Health and Safety Agency for Healthcare; Director of the Institute of Health Promotion Research, University of British Columbia, Vancouver, British Columbia. Marcy Cohen, MA (Education), Director of Research, Hospital Employees’ Union, Vancouver, British Columbia. Yuri Cvitkovich, MA (Gero), Researcher, Institute of Health Pro- motion Research, University of British Columbia, Vancouver, British Columbia. Il Hyoek Park, PhD, Post Doctoral Fellow, Institute of Health Promotion Research, University of British Columbia, Vancouver, British Columbia. Pam Ratner, RN, PhD, Associate Professor, Nursing and Health Behavior Research Unit, School of Nursing, University of British Columbia, Vancouver, British Columbia. Aleck Ostry, PhD, Assistant Professor, Department of Health Care and Epidemiology, University of British Columbia, Vancou- ver, British Columbia. Judy Village, MSc, School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia. Nancy Pollak, MA (candidate), Researcher, Hospital Employees’ Union, Vancouver, British Columbia. NU530207.qxd 3/12/2004 2:04 PM Page 87