Work SMARTey · Managers and leaders
Running a setting is hard enough. Work-related pain makes it harder.
For nursery managers, deputies, room leaders and anyone who runs a setting day to day. Pain might not always be obvious, but it shows up in staff absence, cover, recruitment and the quality of provision. Work SMARTey helps managers and leaders understand, and more effectively reduce, the risks in their own settings.
In brief
What managers and leaders need to know.
Work SMARTey is a research programme on pain among early years staff. Our national study found that 98% of the early years staff we surveyed reported experiencing pain whilst working, and that more than one in three (36%) had thought about leaving their job because of pain. Much of it goes unreported, so settings can have staff in pain every day without it showing up in absence figures. That is why it matters for running a setting: it affects cover, recruitment and retention, the quality of care, and the duty of care to staff.
On this page:
How it shows up
Pain among staff affects the whole setting.
98% of the early years staff we surveyed reported experiencing pain whilst working. It rarely stays a private matter. It shows up in the rota, the budget and the room.
Absence and cover
Ratios must be kept.
When someone is off, ratios still have to be met, so absence often means finding and paying for cover, or stretching the rest of the team. Those who lifted, stooped or worked at floor level more often were in pain more often and more likely to need time off (Turvill et al., 2024).
Recruitment and retention
Pain is pushing good people out.
36% of the staff we surveyed had thought about leaving their job because of pain. One leader told us: “Just preparing my team for me to leave in next 3–5 years as I don’t feel I will be able to do my job role any more as I struggle now.”
Quality of care
Pain affects what staff can give.
Pain can affect what staff are able to give to the children in their care. One leader described how constant pain “affects mental health, passion for the job and my professional effectiveness.”
Duty of care
Policies, procedures and risk.
Employers must assess and reduce manual handling risks so far as is reasonably practicable (Manual Handling Operations Regulations 1992). How roles, rotas and rooms are planned is part of that duty, not an extra.
Tackling the problem
Tackle the source, not just the symptoms.
When pain is reported, most responses are reactive. They come only after the pain has started, they focus on easing the symptoms, and they tend to address one narrow part of the problem. Each can help, but on its own it may not tackle all of the factors that contribute to pain at work, so the pain can keep coming back.
Why approaches so far have not solved it
- They come late. Most support starts after pain has been reported, rather than helping to prevent it.
- They are narrow. A chair, time off or advice on lifting each address one part of what is often a complex problem. Reviews of the evidence find that lifting training on its own does not prevent back pain (Verbeek et al., 2011; Oakman et al., 2024).
- Many staff never reach them. Pain is often treated as part of the job, so it goes unreported and unaddressed.
It can feel like something that would be nice to have when money is tight and there are other priorities. But time off, cover and replacing staff already cost settings money, and many of the changes that help are low cost. In many settings, the cost of a few days of absence and cover would be enough to pay for the first changes.
Early years practice already looks at the whole child. The same thinking applies to the adults who care for them: pain is about more than the body alone, and the work, the environment and the culture of a setting all play a part in how it is experienced and managed.
Frequently asked questions
Is there still a problem if our setting doesn’t have high staff absence because of pain?
Low absence doesn’t necessarily mean low pain, or low cost. Many staff in pain keep working through it, and that never shows up in absence records. Research suggests working through pain costs employers more than time off (Stewart et al., 2003; Goetzel et al., 2004).
See the hidden cost above for the figures.
We already provide manual handling training. Isn’t that enough?
Manual handling training is a legal requirement and should continue. But reviews of the evidence find that lifting training on its own does not prevent back pain (Verbeek et al., 2011; Oakman et al., 2024). In early years, working low down and lifting children who move cannot be avoided, so prevention needs to go further than training.
Can we afford to prioritise this when money is tight?
Many of the changes that help cost little, and some cost nothing. Compare them with what time off, cover and replacing staff may already be costing: our estimate tool can help. Talk to us about where to start.
What if staff say pain is just part of the job?
Many staff see it that way, and that is one of the reasons it goes unreported and nothing changes. In our survey, the longer people had worked in early years, the more parts of their body hurt, and age alone did not explain this. Making it easy and safe to raise pain early is one of the most useful things a manager can do.
How do we get our owner or committee on board?
Decisions about spending, equipment and staffing often sit above the manager. Share this page, or our page for owners and decision makers, which sets out the costs to the organisation and the questions owners ask.
Have a question of your own?
If your question isn’t answered here, ask us directly and we will get back to you.
Next steps
Stay up to date with Work SMARTey.
We are turning what we have learned into practical support and services for settings and early years organisations of all sizes.
Full details of every source are on our Sources and references page.