Nursing aides are particularly susceptible to manual handling injuries because they have the primary responsibility for heavy lifting. The aim of this study was to determine why a specific group of nursing aides have the highest manual handling injury rate in their hospital. The study investigated the adequacy of the manual handling training program, knowledge of manual handling, mechanical aid availability, and use of mechanical aids. Results indicated that the nursing aides' manual handling knowledge was adequate but that they rarely used mechanical aids. This lack of use of aids was in part due to an over-reliance on their own strength and abilities. This may have been due to a lack of suitable mechanical aids on the wards or a lack of familiarity with the available aids. This study suggests that neither training alone nor the purchase of equipment alone is likely to resolve manual handling problems.