Hospital-based clinical training and low back pain in nursing students: prevalence, risk factors, and implications...

Low back pain (LBP) is a common occupational health issue in nursing. Nursing students, often insufficiently trained in ergonomic practices, are particularly vulnerable. Despite its long-term implications for workforce retention and professional well-being, the timing of onset and progression of LBP in this population remain unclear, especially in hospital-based clinical training. In this study, we investigated the onset, prevalence, intensity, and predictors of LBP among nursing students, specifically focusing on the impact of clinical training. Our aim was to inform the development of evidence-based strategies to improve nursing education and promote workforce sustainability.

A comparative, cross-sectional, online, questionnaire-based study was conducted among 194 third- and fourth-year nursing students engaged in clinical training at various hospitals. Logistic regression analyses were conducted for each independent variable, considering the Oswestry Disability Index as the dependent variable (< 12 vs. ≥12, where ≥ 12 indicates the presence of disability), to identify predictors of low back pain.

The prevalence of low back pain increased significantly from 40.7% before nursing school to 75.3% during the past month of clinical training. Independent predictors of low back pain were clinical training-related stress (OR = 1.76, p <.003), and pre-existing musculoskeletal pain (neck/shoulder; OR = 3.05, p <.014). Single students experienced lower rates of LBP than married or divorced/widowed participants (OR = 0.138, p =.018). Pain intensity also increased significantly with daily activities, including lifting, walking, sitting, standing, and sleeping, following clinical training.

Hospital-based clinical training significantly increases the risk of LBP among nursing students, underscoring the need for evidence-based preventive strategies. Based on the study observations, specific interventions should include: (1) mandatory ergonomic training prior to and during clinical placements, (2) the integration of stress management programs into nursing curricula, and (3) routine musculoskeletal screening for the early identification of at-risk students. These strategies may improve physical resilience, reduce injury-related dropout, and support long-term workforce sustainability. Further research is needed to evaluate the effectiveness of these interventions and monitor LBP progression beyond graduation.