Background. Musculoskeletal disorders have continued to plague nurses in hospitals and long-term care facilities. Low back and shoulder injuries are the most prevalent, frequently linked to patient handling activities. Exposure to patient handling has been predominantly quantified by subjective responses of nurses. Objective. To directly observe handling of patients and other medical equipment for nurses during a 12-hour work shift. Methods. Twenty nurses working in three different intensive care units at a Midwest teaching hospital were directly observed during 12-hour day shifts. Direct observation included documenting frequency and type of handling performed and whether lift assist devices were utilized. Two additional surveys were completed by nurses to assess current pain levels and perceptions of lifting being performed. The observed lifting was compared to the perceived lifting with simple inference statistics. Results. Nurses have a high prevalence of manually lifting patients and medical devices but limited use of lifting assist devices. Nurses handled patients 69 times per shift and medical equipment 6 times per shift, but less than 3% utilized a lift assist device. Nurses suffered from high levels of pain at the end of the shift, with the highest prevalence in the lower back, lower legs, and feet/ankles (all above 60%).