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Greetings All,

For the text of HR 6182 "Nurse And Patient Safety and Protection Act of 2006" which was introduced by U.S. Representative John Conyers (D-MI) into the U.S. House of Representatives on September 26, 2006:

Go here http://thomas.loc.gov/home/bills_res.html and click "Search Bill Text." Then, under "Enter Search," select "Bill Number" and type "HR 6182" in the blank box, which takes you to the wording, which also follows below.

Best to all...Anne

Anne Hudson, RN
September 29, 2006
anne@wingusa.org
www.wingusa.org Work Injured Nurses' Group USA

Nurse And Patient Safety & Protection Act of 2006 (Introduced in House)

HR 6182 IH

109th CONGRESS

2d Session
H. R. 6182
To amend the Occupational Safety and Health Act of 1970 to reduce injuries to patients, direct-care registered nurses, and other health care providers by establishing a safe patient handling standard.
IN THE HOUSE OF REPRESENTATIVES

September 26, 2006
Mr. CONYERS introduced the following bill; which was referred to the Committee on Education and the Workforce, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend the Occupational Safety and Health Act of 1970 to reduce injuries to patients, direct-care registered nurses, and other health care providers by establishing a safe patient handling standard.

• Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS.

• (a) Short Title- This Act may be cited as the `Nurse And Patient Safety & Protection Act of 2006'.

• (b) Findings- Congress finds the following:

• (1) Direct-care registered nurses rank 10th among all occupations for musculoskeletal disorders, sustaining injuries at a higher rate than laborers, movers, and truck drivers. In 2004, nurses sustained 8,800 musculoskeletal disorders, most of which (over 7,000) were back injuries. The leading cause of these injuries in health care are the result of patient lifting, transferring, and repositioning injuries.

• (2) The physical demands of the nursing profession lead many nurses to leave the profession. Fifty two percent of nurses complain of chronic back pain and 38 percent suffer from pain severe enough to require leave from work. Many nurses and other health care providers suffering back injury do not return to work.

• (3) Patients are not at optimum levels of safety while being lifted, transferred, or repositioned manually. Mechanical lift programs can substantially reduce skin tears suffered by patients, allowing patients a safer means to progress through their care.

• (4) The development of assistive patient handling equipment and devices has essentially rendered the act of strict manual patient handling unnecessary as a function of nursing care.

• (5) Application of assistive patient handling technology fulfills an ergonomic approach within the nursing practice by designing and fitting the job or workplace to match the capabilities and limitations of the human body.

• (6) A growing number of health care facilities have incorporated patient handling technology and have reported positive results. Injuries among nursing staff have dramatically declined since implementing patient handling equipment and devices. As a result, the number of lost work days due to injury and staff turnover has declined. Cost-benefit analyses have also shown that assistive patient handling technology successfully reduces workers' compensation costs for musculoskeletal disorders.

• (7) Establishing a safe patient handling standard for direct-care registered nurses and other health care providers is a critical component in increasing patient safety, protecting nurses, and addressing the nursing shortage.

SEC. 2. FEDERAL SAFE PATIENT HANDLING STANDARD.

• Not later than 1 year after the date of the enactment of this title, the Secretary of Labor, acting through the Director of Occupational Safety and Health Administration, shall establish a Federal Safe Patient Handling Standard to prevent musculoskeletal disorders for direct-care registered nurses and other health care providers working in health care facilities. This standard shall require the elimination of manual lifting of patients by direct-care registered nurses and other health care providers, through the use of mechanical devices, except during a declared state of emergency. The standard shall include a musculoskeletal injury prevention plan, which will include hazard identification and risk assessments in relation to patient care duties and patient handling. The standard shall require:

• (1) all health care facilities comply with the standard;

• (2) health care facilities to purchase, use, and maintain safe lift mechanical devices;

• (3) input from direct-care registered nurses and organizations representing direct-care registered nurses in implementing the standard;

• (4) a program to identify problems and solutions regarding safe patient handling;

• (5) a system to report, track, and analyze trends in injuries, as well as make injury data available to the public;

• (6) training for staff on safe patient handling policies, equipment, and devices at least on an annual basis. Training will also include hazard identification, assessment and control of musculoskeletal hazards in patient care areas, this would include interactive classroom based and hands on training by a knowledgeable person or staff; and

• (7) annual evaluations of safe patient handling efforts, as well as new technology, handling procedures, and engineering controls. Documentation of this process shall include equipment selection and evaluation.

SEC. 3. REQUIREMENT FOR HEALTH CARE FACILITIES.

• (a) Safe Patient Handling Plan- In accordance with the standard required under section 2, and not later than 6 months after such standard is published, health care facilities shall develop and implement a safe patient handling plan that--

• (1) provides adequate, appropriate, and quality delivery of health care services that protects patient safety and prevents musculoskeletal disorders for direct-care registered nurses and other health care providers;

• (2) is consistent with the requirements of the Federal Safe Patient Handling Standard (as established in section 2);

• (3) provides for input by direct-care registered nurses and organizations representing direct-care registered nurses in implementing the plan; and

• (4) ensures that safe lifting mechanical devices shall only be used by direct care registered nurses and other health care providers.

• (b) Posting, Records, and Auditing-

• (1) POSTING REQUIREMENTS- Not later than 6 months after the standard required under section 2 is published, a health care facility shall post, in each unit of the facility, a uniform notice in a form specified by the Secretary in regulation that--

• (A) explains the Federal Safe Patient Handling Standard issued under section 2;

• (B) includes information regarding safe patient handling polices and training; and

• (C) explains procedure to report patient handling-related injuries.

• (2) AUDITS- The Secretary shall require the Occupational Safety and Health Administration to conduct unscheduled audits to ensure--

• (A) implementation of the safe patient handling plan in accordance with this title; and

• (B) compliance with reporting and reviewing findings for continual improvements to the safe patient handling plan.

SEC. 4. PROTECTION OF DIRECT-CARE REGISTERED NURSES AND OTHER INDIVIDUALS.

• (a) Refusal of Assignment- A direct-care registered nurse or other health care provider may refuse to accept an assignment in a health care facility if--

• (1) the assignment would violate the standard establish under section 2; or

• (2) the direct-care registered nurse or other health care provider is not prepared by education, training, or experience to fulfill the assignment without compromising the safety of any patient or jeopardizing the license of the nurse.

• (b) Retaliation for Refusal of Assignment Barred-

• (1) NO DISCHARGE, DISCRIMINATION, OR RETALIATION- No health care facility shall discharge, discriminate, or retaliate in any manner with respect to any aspect of employment, including discharge, promotion, compensation, or terms, conditions, or privileges of employment, against a direct-care registered nurse or other health care provider based on his or her refusal of a work assignment under subsection (a).

• (2) NO FILING OF COMPLAINT- No health care facility shall file a complaint or a report against a direct-care registered nurse or other health care provider with the appropriate State professional disciplinary agency because of his or her refusal of a work assignment under subsection (a).

• (c) Complaint to Secretary- A direct-care registered nurse, health care provider, or other individual may file a complaint with the Secretary against a health care facility that violates this Act or a standard established under this Act. For any complaint filed, the Secretary shall--

• (1) receive and investigate the complaint;

• (2) determine whether a violation of this Act as alleged in the complaint has occurred; and

• (3) if such a violation has occurred, issue an order that the complaining direct-care registered nurse, health care provider, or other individual shall not suffer any retaliation under subsection (b) or under subsection (d).

• (d) Whistleblower Protection-

• (1) RETALIATION BARRED- A health care facility shall not discriminate or retaliate in any manner with respect to any aspect of employment, including hiring, discharge, promotion, compensation, or terms, conditions, or privileges of employment against any individual who in good faith, individually or in conjunction with another person or persons--

• (A) reports a violation or a suspected violation of this Act or the standard established under this Act to the Secretary, a public regulatory agency, a private accreditation body, or the management personnel of the health care facility;

• (B) initiates, cooperates, or otherwise participates in an investigation or proceeding brought by the Secretary, a public regulatory agency, or a private accreditation body concerning matters covered by this Act; or

• (C) informs or discusses with other individuals or with representatives of health care facility employees a violation or suspected violation of this Act.

• (2) GOOD FAITH DEFINED- For purposes of this subsection, an individual shall be deemed to be acting in good faith if the individual reasonably believes--

• (A) the information reported or disclosed is true; and

• (B) a violation of this Act or the standard established under this Act has occurred or may occur.

• (e) Cause of Action- Any direct-care registered nurse or other health care provider who has been discharged, discriminated, or retaliated against in violation of subsection (b)(1) or (d), or against whom a complaint has been filed in violation of subsection (b)(2), may bring a cause of action in a United States district court. A direct-care registered nurse or other health care provider who prevails on the cause of action shall be entitled to one or more of the following:

• (1) Reinstatement.

• (2) Reimbursement of lost wages, compensation, and benefits.

• (3) Attorneys' fees.

• (4) Court costs.

• (5) Other damages.

• (f) Notice- A health care facility shall include in the notice required under section 3(b) an explanation of the rights of direct-care registered nurses, health care providers, and other individuals under this section and a statement that a direct-care registered nurse, health care provider, or other individual may file a complaint with the Secretary against a health care facility that violates the standard issued under section 2, including instructions for how to file such a complaint.

SEC. 5. DEFINITIONS.

• For purposes of this Act:

• (1) DIRECT-CARE REGISTERED NURSE- The term `direct care registered nurse' means an individual who has been granted a license by at least 1 State to practice as a registered nurse and who provides bedside care or outpatient services for 1 or more patients.

• (2) HEALTH CARE PROVIDER- The term `health care provider' means any person required by State or Federal laws or regulations to be licensed, registered, or certified to provide health care services, and being either so licensed, registered, or certified, or exempted from such requirement by other statute or regulation.

• (3) EMPLOYMENT- The term `employment' includes the provision of services under a contract or other arrangement.

• (4) HEALTH CARE FACILITY- The term `health care facility' means an outpatient health care facility, hospital, nursing home, home health care agency, hospice, federally qualified health center, nurse managed health center, rural health clinic, or any similar healthcare facility that employs direct-care registered nurses.

• (5) DECLARED STATE OF EMERGENCY- The term `declared state of emergency' means an officially designated state of emergency that has been declared by the Federal Government or the head of the appropriate State or local governmental agency having authority to declare that the State, county, municipality, or locality is in a state of emergency, but does not include a state of emergency that results from a labor dispute in the health care industry or consistent under staffing.

SEC. 6. FINANCIAL ASSISTANCE TO NEEDY HEALTH CARE FACILITIES IN THE PURCHASE OF SAFE PATIENT HANDLING EQUIPMENT.

• (a) In General- The Secretary of Health and Human Services shall establish a grant program that provides financial assistance to cover some or all of the costs of purchasing safe patient handling equipment for health care facilities, such as hospitals, nursing facilities, and outpatient facilities, that--

• (1) require the use of such equipment in order to comply with the standards established under section 2; but

• (2) demonstrate the financial inability to otherwise afford the purchase of such equipment are provided grants for some or all of the cost of purchasing such equipment.

• (b) Application- No financial assistance shall be provided under this section except pursuant to an application made to the Secretary in such form and manner as the Secretary shall specify. The Secretary shall establish a fair standard whereby the facility must clearly demonstrate true financial need in order to establish eligibility for the grant program.

• (c) Authorization of Appropriations- There are authorized to be appropriated for financial assistance under this section $50,000,000, which shall remain available until expended.
END
_________________________________________________________________________________

Dear friends,

Exciting news as more states have introduced and have passed legislation for safe patient handling (SPH). With my last report, I had missed that Illinois introduced SPH legislation in January 2006 and that Hawaii adopted a resolution in April 2006 supporting SPH policies in American Nurses Association’s “Handle With Care” Campaign. More recently, Rhode Island passed SPH legislation in June 2006. (See details following below on Illinois, Hawaii, and Rhode Island.)

And, after two vetoes by California Governor Arnold Schwarzenegger, for the third time, SPH has passed the California Legislature and was delivered to the governor on September 12, 2006, with action by the governor pending at this writing.

As the number of states with legislative activity for safe patient handling continues to grow, on the way to a national mandate for “safe patient handling—no manual lift,” I will attempt to keep you informed. However, there are many states, and I may be unaware of their progress. So, please email info on initiatives for safe patient handling in your state and I will be glad to forward to all.

Wording of legislation passed and introduced by the following states can be used as model language for drafting initiatives in remaining states.

States Which Have Passed Laws for Safe Patient Handling and Pertaining to Safe Patient Handling

Texas SB 1525, 6-17-05: First to mandate implementation of policy for safe patient handling and movement programs by hospitals and nursing homes.
http://www.capitol.state.tx.us/tlo/79R/billtext/SB01525F.HTM.

Washington HB 1672, 3-22-06: First to mandate provision of lift equipment by hospitals as part of their policy for safe patient handling; financial assistance with implementation by tax credits and reduced workers’ compensation premiums.
http://www.leg.wa.gov/pub/billinfo/2005-06/Pdf/Bills/House%20Passed%20Legislature/1672-S.PL.pdf.

Hawaii House Concurrent Resolution No. 16, 4-24-06: Safeguards to be instituted in health care facilities to minimize the occurrence of musculoskeletal injuries suffered by nurses; calls for the Legislature of Hawaii to support policies in ANA’s Handle With Care Campaign.
http://www.capitol.hawaii.gov/sessioncurrent/bills/HCR16_.pdf

Rhode Island H 7386 and S 2760, 7-7-06: Hospitals and nursing facilities to “achieve maximum reasonable reduction of manual lifting, transferring, and repositioning …except in emergency, life-threatening, or otherwise exceptional circumstances.”
http://www.rilin.state.ri.us/Billtext/BillText06/HouseText06/H7386Aaa.pdf and
http://www.rilin.state.ri.us/Billtext/BillText06/SenateText06/S2760A.pdf

Ohio HB 67, 3-21-05: Created workers’ comp loan for interest-free loans to nursing homes for lift equipment and implementing “No Manual Lifting of Residents” policy. http://www.legislature.state.oh.us/bills.cfm?ID=126_HB_67_EN

New York A07641 and S04929, 10-18-05: Created two-year “Safe Patient Handling Demonstration Program” to collect data on injuries and describe best practices.
http://assembly.state.ny.us/leg/?bn=A07641&sh=t and http://assembly.state.ny.us/leg/?bn=S04929&sh=t

States Which Have Introduced Safe Patient Handling Legislation

Illinois Introduces Legislation for Safe Patient Handling

Companion bills for safe patient handling, "Nursing Home-Hospital-Handle Patients," were introduced into the House and the Senate of Illinois in January of this year. On January 11, 2006, House Bill 4558 was introduced by Representative Angelo Saviano. On January 20, 2006, Senate Bill 2692 was introduced by Senator Donne E. Trotter.

If passed, IL HB 4558 and SB 2692, which have identical wording, will “Require every nursing home and hospital to adopt and ensure implementation of a policy to identify, assess, and develop strategies to control the risk of injury to residents, patients, and nurses associated with the lifting, transferring, repositioning, or movement of a resident or patient.” The Illinois Nursing Home Care Act and the Hospital Licensing Act both would be amended, requiring “Restriction, to the extent feasible with existing equipment and aids, of manual resident [or patient] handling or movement of all or most of a resident’s [or patient's] weight to emergency, life-threatening, or otherwise exceptional circumstances.”

Specifically required would be an analysis of the risk of injury to residents, patients, and nurses with handling needs, and education of nurses to identify, assess, and control the risk of injury to residents, patients, and nurses with resident or patient handling. Procedures would be implemented for a nurse to refuse to perform patient or resident handling or movement which the nurse believes in good faith would expose the patient, resident, or nurse to an unacceptable risk of injury.

Wording of IL HB 4558:
http://www.ilga.gov/legislation/94/HB/PDF/09400HB4558lv.pdf

Wording of IL SB 2692:
http://www.ilga.gov/legislation/fulltext.asp?DocName=09400SB2692lv&SessionID=50&GA=94&DocTypeID=SB&DocNum=2692&print=true

Bill status: http://www.ilga.gov/legislation/BillStatus.asp?DocNum=2692&GAID=8&DocTypeID=SB&LegID=23638&SessionID=50&SpecSess=&Session=&GA=94

Hawaii Adopts Resolution to Support ANA’s “Handle With Care” Campaign for Safe Patient Handling

On February 3, 2006, Hawaii House Concurrent Resolution No. 16, “Requesting appropriate safeguards be instituted in health care facilities to minimize the occurrence of musculoskeletal injuries suffered by nurses,” was introduced by Representatives Lee, Cabanilla, Evans, Shimabukuro, Takumi, Tsuji, Caldwell, Green, Herkes, Kanoho, Kawakami, Nakasone, Schatz, Souki, Takamine, and Tanaka. The report associated with HCR 16 is titled “American Nurses Association's Handle With Care Campaign Support.”

On April 24, 2006, Hawaii adopted HCR 16, recognizing that “work-related musculoskeletal disorders are the leading occupational health problem plaguing the nursing workforce; [that]…nursing personnel are among the highest at risk for musculoskeletal disorders; [that]…of primary concern are back injuries, which can be severely debilitating for nurses…[and that] compared to other occupations, nursing personnel are among the highest at risk for musculoskeletal disorders.”

The resolution calls for the Legislature of Hawaii to support policies provided in American Nurses Association’s “Handle With Care” campaign for safe patient handling, “…to control ergonomic hazards in the health care workplace and prevent back injuries among the nation's nursing workforce.”

On June 21, 2003, ANA’s “Position Statement on Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders” became effective. “In order to establish a safe environment of care for nurses and patients, the American Nurses Association (ANA) supports actions and policies that result in the elimination of manual patient handling.” See http://www.nursingworld.org/readroom/position/workplac/pathand.htm.

On September 17, 2003, the announcement “ANA Launches 'Handle with Care' Ergonomics Campaign” was released, “aimed at preventing work-related musculoskeletal disorders through greater use of assistive equipment and patient-handling devices.” See http://nursingworld.org/pressrel/2003/pr0917.htm. In early 2004, ANA’s "Handle with Care" brochure with accompanying CD was sent to every hospital in the United States. See http://www.nursingworld.org/handlewithcare/hwc.pdf.

HCR16 states: “In 2005, the Council of State Governments' Health Capacity Task Force adopted and supported the policies contained in the American Nurses Association's Handle With Care campaign and asked member states to also support the campaign.”

With adoption of HCR 16, Hawaii says, “Be it resolved…that the Legislature of the State of Hawaii supports the policies contained in the American Nurses Association's Handle With Care campaign; and… that certified copies of this Concurrent Resolution be transmitted to the Council of State Governments' Health Capacity Task Force and the American Nurses Association.”

History of HI HCR 16:
http://www.capitol.hawaii.gov/site1/docs/getstatus2.asp?billno=HCR16.

Wording of HI HCR 16:
http://www.capitol.hawaii.gov/sessioncurrent/bills/HCR16_.pdf

Rhode Island Passes Safe Patient Handling Legislation

Rhode Island has joined other states in addressing musculoskeletal injuries to healthcare workers caused by manual patient lifting with legislation requiring healthcare facilities to practice safe patient handling.

RI Senate Bill 2760 was introduced by Senators Sosnowski, Lanzi, Perry, Paiva-Weed, and Pichardo on February 14, 2006. RI House Bill 7386 was introduced by Representatives Diaz, Moura, Rice, Ajello, and Sullivan on February 16, 2006.

According to Rhode Island's "Legislative Status Report" at http://dirac.rilin.state.ri.us/BillStatus/WebClass1.ASP?WCI=BillStatus&WCE=ifrmBillStatus&WCU, companion bills SB 2760 and HB 7386, both entitled “An Act Relating to Health and Safety – Safe Patient Handling Legislation,” were transmitted on June 29, 2006, to Governor Donald L. Carcieri (R). Rhode Island’s “Safe Patient Handling Act of 2006,” “to promote the safe handling of patients in health care facilities,” became law on July 7, 2006, without Governor Carcieri’s signature.

Rhode Island’s Safe Patient Handling Act of 2006, which will take effect on January 1, 2007, covers both hospitals and nursing facilities, calling for “use of engineering controls, transfer aids, or assistive devices whenever feasible and appropriate instead of manual lifting to perform the acts of lifting, transferring, and/or repositioning health care patients and residents.”

Following establishment of a safe patient handling committee, and development of a written safe patient handling program, by July 1, 2008, healthcare facilities shall “implement a safe patient handling policy for all shifts and units of the facility that will achieve the maximum reasonable reduction of manual lifting, transferring, and repositioning of all or most of a patient's weight, except in emergency, life-threatening, or otherwise exceptional circumstances.”

Rhode Island’s new Safe Patient Handling Act of 2006 will increase healthcare safety by mandating use of modern technology to decrease injuries traditionally suffered by nursing staff, patients, and residents as the result of unsafe manual lifting and movement.

Here are websites for wording of the two bills with complete wording of Rhode Island’s Safe Patient Handling Act of 2006 following below.

Wording of RI SB 2760:   http://www.rilin.state.ri.us/Billtext/BillText06/SenateText06/S2760A.pdf

Wording of RI HB 7386:
http://www.rilin.state.ri.us/Billtext/BillText06/HouseText06/H7386Aaa.pdf

Anne Hudson, RN, BSN
Work Injured Nurses’ Group USA
anne@wingusa.org
September 14, 2006

2006 -- S 2760 SUBSTITUTE A, LC01138/SUB A/2
2006 -- H 7386 SUBSTITUTE A AS AMENDED, LC01442/SUB A/2

STATE OF RHODE ISLAND IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2006

AN ACT RELATING TO HEALTH AND SAFETY – SAFE PATIENT HANDLING LEGISLATION

S 2760 Introduced on February 14, 2006, by: Senators Sosnowski, Lanzi, Perry, Paiva-Weed, and Pichardo

H 7386 Introduced on February 16, 2006, by: Representatives Diaz, Moura, Rice, Ajello, and Sullivan

It is enacted by the General Assembly as follows:

SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby amended by adding thereto the following chapter:

CHAPTER 80 SAFE PATIENT HANDLING ACT OF 2006

23-80-1. Short title. – (a) This chapter shall be known and may be cited as the "Safe Patient Handling Act of 2006."

23-80-2. Legislative findings. –
(a) Patients are at greater risk of injury, including skin tears, falls, and musculoskeletal injuries, when being lifted, transferred, or repositioned manually.

(b) Safe patient handling can reduce skin tears suffered by patients by threefold, and can significantly reduce other injuries to patients as well.

(c) Health care workers lead the nation in work-related musculoskeletal disorders. Between thirty-eight percent (38%) and fifty percent (50%) of nurses and other health care workers will suffer a work-related back injury during their career. Forty-four percent (44%) of these workers will be unable to return to their pre-injury position.

(d) Research indicates that nurses lift an estimated 1.8 tons per shift. Eighty-three percent (83%) of nurses work in spite of back pain, and sixty percent (60%) of nurses fear a disabling back injury. Twelve percent (12%) to thirty-nine percent (39%) of nurses not yet disabled are considering leaving nursing due to back paid and injuries.

(e) Safe patient handling reduces injuries and costs. In nine (9) case studies evaluating the impact of lifting equipment, injuries decreased sixty percent (60%) to ninety-five percent (95%). Workers' Compensation costs dropped by ninety-five percent (95%), and absenteeism due to lifting and handling was reduced by ninety-eight percent (98%).

SECTION 2. Chapter 23-17 of the General Laws entitled "Licensing of Health Care Facilities" is hereby amended by adding thereto the following section:

23-17-58. Safe patient handling. –

(1) Definitions. - As used in this chapter:

(a) "Safe patient handling" means the use of engineering controls, transfer aids, or assistive devices whenever feasible and appropriate instead of manual lifting to perform the acts of lifting, transferring, and/or repositioning health care patients and residents.

(b) "Safe patient handling policy" means protocols established to implement safe patient handling.

(c) "Health care facility" means a hospital or a nursing facility.

(d) "Lift team" means health care facility employees specially trained to perform patient lifts, transfers, and repositioning in accordance with safe patient handling policy.

(e) "Musculoskeletal disorders" means conditions that involve the nerves, tendons, muscles, and supporting structures of the body.

(2) Licensure requirements. - Each licensed health care facility shall comply with the following as a condition of licensure:

(a) Each licensed health care facility shall establish a safe patient handling committee, which shall be chaired by a professional nurse or other appropriate licensed health care professional. A health care facility may utilize any appropriately configured committee to perform the responsibilities of this section. At least half of the members of the committee shall be hourly, non-managerial employees who provide direct patient care.

(b) By July 1, 2007, each licensed health care facility shall develop a written safe patient handling program, with input from the safe patient handling committee, to prevent musculoskeletal disorders among health care workers and injuries to patients. As part of this program, each licensed health care facility shall:

(i) By July 1, 2008, implement a safe patient handling policy for all shifts and units of the facility that will achieve the maximum reasonable reduction of manual lifting, transferring, and repositioning of all or most of a patient's weight, except in emergency, life-threatening, or otherwise exceptional circumstances;

(ii) Conduct a patient handling hazard assessment. This assessment should consider such variables as patient-handling tasks, types of nursing units, patient populations, and the physical environment of patient care areas;

(iii) Develop a process to identify the appropriate use of the safe patient handling policy based on the patient's physical and mental condition, the patient's choice, and the availability of lifting equipment or lift teams. The policy shall include a means to address circumstances under which it would be medically contraindicated to use lifting or transfer aids or assistive devices for particular patients;

(iv) Designate and train a registered nurse or other appropriate licensed health care professional to serve as an expert resource, and train all clinical staff on safe patient handling policies, equipment, and devices before implementation, and at least annually or as changes are made to the safe patient handling policies, equipment and/or devices being used;

(v) Conduct an annual performance evaluation of the safe patient handling with the results of the evaluation reported to the safe patient handling committee or other appropriately designated committee. The evaluation shall determine the extent to which implementation of the program has resulted in a reduction in musculoskeletal disorder claims and days of lost work attributable to musculoskeletal disorder caused by patient handling, and include recommendations to increase the program's effectiveness; and

(vi) Submit an annual report to the safe patient handling committee of the facility, which shall be made available to the public upon request, on activities related to the identification, assessment, development, and evaluation of strategies to control risk of injury to patients, nurses and other health care workers associated with the lifting, transferring, repositioning, or movement of a patient.

(c) Nothing in this section precludes lift team members from performing other duties as assigned during their shift.

(d) An employee may, in accordance with established facility protocols, report to the committee, as soon as possible, after being required to perform a patient handling activity that he/she believes in good faith exposed the patient and/or employee to an unacceptable risk of injury. Such employee reporting shall not be cause for discipline or be subject to other adverse consequences by his/her employer. These reportable incidents shall be included in the facility's annual performance evaluation.

SECTION 3. Section 23-15-4 of the General Laws in Chapter 23-15 entitled "Determination of Need for New Health Care Equipment and New Institutional Health Services" is hereby amended to read as follows:

23-15-4. Review and approval of new health care equipment and new institutional health services. –

(a) No health care provider or health care facility shall develop or offer new health care equipment or new institutional health services in Rhode Island, the magnitude of which exceeds the limits defined by this chapter, without prior review by the health services council and approval by the state agency; except that review by the health services council may be waived in the case of expeditious reviews conducted in accordance with section 23-15-5, and except that health maintenance organizations which fulfill criteria to be established in rules and regulations promulgated by the state agency with the advice of the health services council shall be exempted from the review and approval requirement established in this section upon approval by the state agency of an application for exemption from the review and approval requirement established in this section which contain any information that the state agency may require to determine if the health maintenance organization meets the criteria.

(b) No approval shall be made without an adequate demonstration of need by the applicant at the time and place and under the circumstances proposed, nor shall the approval be made without a determination that a proposal for which need has been demonstrated is also affordable by the people of the state.

(c) No approval of new institutional health services for the provision of health services to inpatients shall be granted unless the written findings required in accordance with section 23-15-16 6(b)(6) are made.

(d) Applications for determination of need shall be filed with the state agency on a date fixed by the state agency together with plans and specifications and any other appropriate data and information that the state agency shall require by regulation, and shall be considered in relation to each other no less than once a year. A duplicate copy of each application together with all supporting documentation shall be kept on file by the state agency as a public record.

(e) The health services council shall consider, but shall not be limited to, the following in conducting reviews and determining need:

(1) The relationship of the proposal to state health plans that may be formulated by the state agency;

(2) The impact of approval or denial of the proposal on the future viability of the applicant and of the providers of health services to a significant proportion of the population served or proposed to be served by the applicant;

(3) The need that the population to be served by the proposed equipment or services has for the equipment or services;

(4) The availability of alternative, less costly, or more effective methods of providing services or equipment, including economies or improvements in service that could be derived from feasible cooperative or shared services;

(5) The immediate and long term financial feasibility of the proposal, as well as the probable impact of the proposal on the cost of, and charges for, health services of the applicant;

(6) The relationship of the services proposed to be provided to the existing health care system of the state;

(7) The impact of the proposal on the quality of health care in the state and in the population area to be served by the applicant;

(8) The availability of funds for capital and operating needs for the provision of the services or equipment proposed to be offered;

(9) The cost of financing the proposal including the reasonableness of the interest rate, the period of borrowing, and the equity of the applicant in the proposed new institutional health service or new equipment;

(10) The relationship, including the organizational relationship of the services or equipment proposed, to ancillary or support services;

(11) Special needs and circumstances of those entities which provide a substantial portion of their services or resources, or both, to individuals not residing within the state;

(12) Special needs of entities such as medical and other health professional schools, multidisciplinary clinics, and specialty centers; also, the special needs for and availability of osteopathic facilities and services within the state;

(13) In the case of a construction project:

(i) The costs and methods of the proposed construction, and

(ii) The probable impact of the construction project reviewed on the costs of providing health services by the person proposing the construction project; and

(iii) The proposed availability and use of safe patient handling equipment in the new or renovated space to be constructed.

(14) Those appropriate considerations that may be established in rules and regulations promulgated by the state agency with the advice of the health services council;

(15) The potential of the proposal to demonstrate or provide one or more innovative approaches or methods for attaining a more cost effective and/or efficient health care system;

(16) The relationship of the proposal to the need indicated in any requests for proposals issued by the state agency;

(17) The input of the community to be served by the proposed equipment and services and the people of the neighborhoods close to the health care facility who are impacted by the proposal;

(18) The relationship of the proposal to any long-range capital improvement plan of the health care facility applicant.

(f) In conducting its review, the health services council shall perform the following:

(1) Within one hundred and fifteen (115) days after initiating its review, which must be commenced no later than thirty-one (31) days after the filing of an application, the health services council shall determine as to each proposal whether the applicant has demonstrated need at the time and place and under the circumstances proposed, and in doing so may apply the criteria and standards set forth in subsection (e) of this section; provided however, that a determination of need shall not alone be sufficient to warrant a recommendation to the state agency that a proposal should be approved. The director shall render his or her decision within five (5) days of the determination of the health services council.

(2) Prior to the conclusion of its review in accordance with section 23-15-6(e), the health services council shall evaluate each proposal for which a determination of need has been established in relation to other proposals, comparing proposals with each other, whether similar or not, establishing priorities among the proposals for which need has been determined, and taking into consideration the criteria and standards relating to relative need and affordability as set forth in subsection (e) of this section and section 23-15-6(f).

(3) At the conclusion of its review, the health services council shall make recommendations to the state agency relative to approval or denial of the new institutional health services or new health care equipment proposed; provided that:

(i) The health services council shall recommend approval of only those proposals found to be affordable in accordance with the provisions of section 23-15-6(f); and

(ii) If the state agency proposes to render a decision that is contrary to the recommendation of the health services council, the state agency must render its reasons for doing so in writing.

(g) Approval of new institutional health services or new health care equipment by the state agency shall be subject to conditions that may be prescribed by rules and regulations developed by the state agency with the advice of the health services council, but those conditions must relate to the considerations enumerated in subsection (e) and to considerations that may be established in regulations in accordance with subsection (e) (14).

(h) The offering or developing of new institutional health services or health care equipment by a health care facility without prior review by the health services council and approval by the state agency shall be grounds for the imposition of licensure sanctions on the facility, including denial, suspension, revocation, or curtailment or for imposition of any monetary fines that may be statutorily permitted by virtue of individual health care facility licensing statutes.

(i) No government agency and no hospital or medical service corporation organized under the laws of the state shall reimburse any health care facility or health care provider for the costs associated with offering or developing new institutional health services or new health care equipment unless the health care facility or health care provider has received the approval of the state agency in accordance with this chapter. Government agencies and hospital and medical service corporations organized under the laws of the state shall, during budget negotiations, hold health care facilities and health care providers accountable to operating efficiencies claimed or projected in proposals which receive the approval of the state agency in accordance with this chapter.

(j) In addition, the state agency shall not make grants to, enter into contracts with, or recommend approval of the use of federal or state funds by any health care facility or health care provider which proceeds with the offering or developing of new institutional health services or new health care equipment after disapproval by the state agency.

SECTION 4. This act shall take effect on January 1, 2007.

Retrieved from: http://releases.usnewswire.com/printing.asp?id=73343

U.S. Newswire - Medialink Worldwide

Michigan and Nation's Largest RN Unions Endorse Conyers Safe Patient Handling Bill

9/27/2006 5:37:00 PM

To: National Desk

Contact: Carol Feuss of Michigan Nurses Association, 517-349-5640 or 517-230-4086; Suzanne Martin of United American Nurses, 301-628-5133

SILVER SPRING, Md., Sept. 27 /U.S. Newswire/ -- A new federal bill introduced Monday by Rep. John Conyers (D-MI) will give direct care nurses the protection they need to safely treat and move patients without running the risk of debilitating musculoskeletal disorders, say leaders of the United American Nurses, AFL-CIO (UAN) and its Michigan affiliate, the Michigan Nurses Association (MNA).

UAN and MNA have worked closely with Rep. Conyers to provide nurses' input on this landmark legislation to protect RNs from lifting and handling injuries and ensure safer patient care.

Direct care RNs get injured at a higher rate than laborers, movers and truck drivers from repositioning, moving and lifting patients, according to the Bureau of Labor Statistics. Workrelated lifting injuries in turn lead many nurses to leave the profession, with more than half of all nurses complaining of chronic back pain and 38 percent of nurses suffering from pain severe enough to require leave from work.

"No nurse should have to sacrifice his or her own health to care for patients," said UAN President Cheryl L. Johnson, RN, who is also president of the Michigan Nurses Association. "If we hope to protect patients and address the current nurse staffing crisis, we must do a better job of protecting nurses at the bedside so that they will choose to stay at the bedside instead of pursuing other, less dangerous career paths. The bill introduced by Rep. Conyers will help accomplish that."
The Nurse and Patient Safety & Protection Act of 2006 (H.R. 6182) will protect nurses by:
-- Establishing a Federal Safe Patient Handling Standard to be administered by the Occupational Safety and Health Administration within one year of the bill's enactment. The standard will eliminate manual lifting of patients by nurses except in case of emergency and require all hospitals to purchase and use safe patient lift mechanical devices, with input from RNs and organizations representing RNs.
-- Requiring hospitals to implement a safe patient handling plan within one year of the bill's enactment that is consistent with the requirements of the federal standard and that provides quality delivery of health care services to protect patient safety and nurses' health;
-- Requiring the posting of information on the federal standard and unscheduled audits to ensure compliance;
-- Including strong whistleblower and refusal of assignment protections for nurses who speak out against non-compliance and penalties for hospitals which do not comply.
"We are pleased to work with Rep. Conyers on this important piece of legislation," added Johnson. "Nurses around the country are ready to fight for this measure, which not only protects nurses but helps patients get the care they need by making hospital nursing jobs more attractive.
We intend to let other Congress members know about the devastating effects of unsafe lifting on nurses and we expect they will agree that now, more than ever, patients need safe care from their registered nurses when they check into the hospital."
---
The Michigan Nurses Association, nurses' voice for 100 years, is the largest nurses' union in the State of Michigan. The Michigan Nurses Association (MNA) promotes the economic and general welfare of nurses in the workplace, fosters high standards of nursing practice, and lobbies the legislature and regulatory agencies on health care issues affecting nurses and recipients of nursing services. MNA is a constituent member of the American Nurses Association and the United American Nurses, as well as an affiliate of the AFL-CIO.
The United American Nurses, AFL-CIO, the collective bargaining affiliate of the American Nurses Association, is the nation's largest RN union, representing more than 100,000 nurses and including 27 state nurses associations or collective bargaining program affiliates.
http://www.usnewswire.com/
© 2006 U.S. Newswire 202-347-2770/

Dear WING USA:

To let you know of the momentous move of our country toward national legislation for safe patient handling.

Yesterday, on 9-26-06, U.S. Representative John Conyers (MI-14) introduced HR 6182, the long-awaited bill to amend the OSH Act of 1970 with establishment of a safe patient handling standard for the United States of America.

A query at http://thomas.loc.gov/ in "Browse Bills by Sponsor" for "Conyers, John, Jr [D-MI-14] gives the site http://thomas.loc.gov/cgi-bin/bdquery with Item # 45:

"H.R.6182 : To amend the Occupational Safety and Health Act of 1970 to reduce injuries to patients, direct-care registered nurses, and other health care providers by establishing a safe patient handling standard.

"Sponsor: Rep Conyers, John, Jr. [MI-14] (introduced 9/26/2006). Cosponsors (None).
"Committees: House Education and the Workforce; House Energy and Commerce.
"Latest Major Action: 9/26/2006 Referred to House committee. Status: Referred to the Committee on Education and the Workforce, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned."

The link from H.R.6182 explains that the text of HR 6182 is not yet available online because "The text of H.R.6182 has not yet been received from GPO [Government Printing Office]. Bills are generally sent to the Library of Congress from the Government Printing Office a day or two after they are introduced on the floor of the House or Senate. Delays can occur when there are a large number of bills to prepare or when a very large bill has to be printed."

The text of HR 6182 as introduced should be available soon online.

Best wishes to all as we celebrate this historic step toward national protection for healthcare workers and patients from preventable injuries with patient handling...Anne

Anne Hudson, RN
September 27, 2006
anne@wingusa.org
www.wingusa.org Work Injured Nurses' Group USA

Greetings WING USA,

NurseWeek has graciously granted permission to forward their "Five Minutes With" interview by Don Vaughan, June 19, 2006, titled "Anne Hudson, RN, On 'No Lift' Legislation" (following below) with the link to NurseWeek's website.

The website is http://www.nurseweek.com/ and the article can be accessed by clicking on "Read current NurseWeek magazine articles" Then click "California Edition" or "Mountain West Edition." Then scroll down and click the article title (as more recent editions are published, you will need to click the "older" button and then click the article title) which links to this page: http://www2.nurseweek.com/Articles/article.cfm?AID=22082 (NurseWeek California Edition).

NurseWeek California and NurseWeek Mountain West Editions both carried the interview article, as well as the "Up Front" editorial "Backing Up Nurses" by Judith Berg, RN, MS, CHE, Vice President of Professional and Editorial Services of NurseWeek Mountain West, and also the cover story "Watching Our Backs" by Phil McPeck which features nurses passionate about successful programs for preventing nurse injury caused by patient lifting.

NurseWeek California's cover story, "Watching Our Backs - RNs Get a Lift from 'No Lift' Policies," features Washington State's new law mandating patient lift equipment in all hospitals.  "['No Lift'] is where all of nursing is headed, says Kim Armstrong, RN, president of the Washington State Nurses Association. 'It has to go to no lift because so many people in the health profession - aides, orderlies and RNs included - are receiving lifetime injuries,' she says."

In the editorial "Backing Up Nurses," Judith Berg reports that 35 years of research have proven that training in body mechanics, safe lifting techniques, and back belts are not effective in reducing injuries with patient lifting. She says, "...health care facilities need to stop using outdated approaches and replace them with evidence-based strategies."

Much gratitude to NurseWeek for extensive coverage of the ready solutions to devastating musculoskeletal injuries caused by manual patient lifting and for publishing Don Vaughan's interview of myself highlighting the need for federal legislation requiring the healthcare industry to practice safe patient handling with mechanical lift equipment instead of with the backs of nurses and other healthcare workers.

A note about the photo in the article: Credit to Elizabeth Langford, AM, RN, RM, BN, Grad. Dip. (Adv. Nsg), Coordinator of the Injured Nurses Support Group in Melbourne, Victoria, Australia, who took the photo when I spoke at the Australian Nursing Federation Victorian Branch "No Lifting Expo," on November 23, 2005. Elizabeth Langford and I are international counterparts in working toward nurse injury prevention and as advocates for injured nurses.

Please see Don Vaughan's interview, "Anne Hudson, RN - On 'No Lift' Legislation," following and at http://www.nurseweek.com.

Best wishes to each of you...Anne

Anne Hudson, RN, BSN
anne@wingusa.org
www.wingusa.org Work Injured Nurses' Group USA
July 4, 2006

"Anne Hudson, RN - On 'No Lift' Legislation." Don Vaughn. June 19, 2006. Five Minutes With. NurseWeek Mountain West Edition. 7(13), 12. Online: http://www.nurseweek.com/. Then, http://www2.nurseweek.com/Articles/article.cfm?AID=22150 (Mt W) and http://www2.nurseweek.com/Articles/article.cfm?AID=22082 (CA).

Anne Hudson, RN — On “No Lift” Legislation
By Don Vaughan
June 19, 2006

Photo by Elizabeth Langford

Anne Hudson, RN, BSN, of Coos Bay, Ore., knows firsthand the debilitating musculoskeletal injuries that can afflict nurses who are required to manually lift patients. Following a painful back injury in 2000, she started a website called B.I.N. There – Back-Injured Nurses, which was later renamed the Work Injured Nurses’ Group USA.

In the years since, Hudson, who is now a public health nurse, has become a vocal proponent of state and federal “safe patient handling – no manual lift” legislation, and lectures often on the hazards of manual lifting and the financial/workforce rewards that can result from the use of patient-lift equipment.

Q How did you become involved with the issue of “no lift” legislation?

All health care workers combined suffer more musculoskeletal injuries than any other occupation in America — with back injury from lifting patients removing more nurses from the bedside than any other kind of injury. I discovered that even though research shows that manual patient lifting cannot be done safely, and that modern patient-lift equipment prevents injuries, many nursing schools still teach manual lifting and many hospitals and nursing homes do not provide safe lift equipment.

Even though the Occupational Safety and Health Act (OSHA) of 1970 General Duty clause states that all workplaces are to be “ … free from recognized hazards that are causing or likely to cause death or serious physical harm,” many facilities still [require nurses to manually lift patients.]

Q What exactly is “no lift” legislation? What is your organization trying to achieve nationally and worldwide?

A comprehensive national “safe patient handling – no manual lift” law would require mechanical lifting equipment and friction-reducing devices for all health care workers, patients, and residents across all health care settings. There simply is no such thing as safe manual patient lifting, for either nursing staff or for patients, who may suffer pain, skin tears, abrasions, bruising, dislocations, fractures, tube dislodgement, and being dropped.

Q Tell us about your own experiences with patient-lift issues.

As a hospital floor nurse, I felt strong and healthy. I lifted and moved patients manually throughout every shift as I had been taught in nursing school and as practiced throughout the hospital. I was happy to assist other nurses with their patients, as well. I naively believed that hospitals would help nurses injured in their service to remain with them. Because the handling of injured employees was never discussed at any nurse bargaining unit meetings or hospital employee meetings, nurses were generally unaware of what to expect from the workers’ compensation system if they became disabled by lifting.

Additionally, nurses were never taught how microfractures occur to spinal discs and vertebral endplates over time from repetitively lifting hazardous amounts of weight. Because there are no pain receptors in the center of discs and in the vertebral endplates, microfractures may occur without pain until sudden extreme pain announces a severe spinal injury and the potential end of a nurse’s career.

Q How close are we to the passage of national “no lift” legislation?

I believe that as more states introduce and pass legislation for safe patient handling, momentum will build, leading quickly to a national “no manual lift for health care” standard. With many dedicated people working toward this end, with the safety of patients and residents at risk, and with the country’s limited supply of nurses and other health care workers jeopardized by current dangerous manual lifting practices, I believe there are no barriers which cannot be overcome to achieve national legislation.

Q What is your organization doing to make nurses and others aware of this issue?

I continue speaking and writing about the danger of manual patient lifting to help get the word out. I believe it is especially important to teach nurses how and why insidious damage occurs to spinal structures from repetitively lifting hazardous amounts of weight. Nurses who understand how spinal damage may occur over time without pain until the injury is severe often become champions for “no lift” policies with use of lift equipment.

Q What can nurses do to promote the passage of “no lift” legislation in their states?

They need to lobby their state legislators to introduce a “safe patient handling – no manual lift” bill. Wording for draft legislation may be patterned after states that have passed and that have introduced legislation, building upon the best language from each state.

Additionally, lobbying insurance companies for coverage of lift equipment for home use, including overhead ceiling lift systems, is essential to help dependent persons remain in their homes and to prevent injuries to family members and home care workers who assist with lifting and movement. The primary reason people move to long-term care facilities is inability of family members to lift and move them. Insurance companies should assist dependent persons to remain at home.

Don Vaughan is a freelance writer for NurseWeek. To comment on this story, send e-mail to editorca@nurseweek.com.

Copyright 2006. Nursing Spectrum Nurse Wire (www.nursingspectrum.com). All rights reserved. Used with permission.

United American Nurses, AFL-CIO Announces Commitment to Federal Legislation
for Safe Patient Handling, Prevention of Nurse Injury from Patient Lifting

Following introduction of a resolution in March 2006, by Maggie Flanagan, RN, Washington State Nurses Association, calling for "the ban of manual movement of patients where safer technology has already been developed," United American Nurses (UAN) National Labor Assembly (NLA) unanimously passed the resolution and UAN has announced working with Representative John Conyers (D) of Michigan toward national legislation to prevent injuries to nurses caused by manual patient lifting.

Legislation related to safe patient handling has already passed and has been introduced in several states. Now, with involvement of United American Nurses, AFL-CIO, efforts are moving toward introduction of national legislation to stop devastating musculoskeletal injuries from physically lifting patients.  Such painful back, neck, and shoulder injuries have been permitted to take their toll on the health, lives, and careers of nurses and other healthcare workers for far too long. It is welcome news that a national legislator has responded to the cry to stop disabling our country's limited supply of healthcare workers by requiring them to lift outrageous amounts of weight.

Ideally, national legislation for safe patient handling would outlaw the manual lifting of patients and would require use of safe mechanical patient lift equipment by nurses, nursing assistants, lift teams, and all other healthcare workers, across all acute care, long-term care, and residential care settings, wherever dependent patients and residents require assistance with lifting and movement needs.  A national "no manual patient lifting" standard would also reduce pain and injuries to patients such as skin tears, abrasions, dislocations, tube dislodgement, and being dropped, which sometimes occur during attempts by nursing staff to manually lift.

Notably the resolution introduced by Maggie Flanagan calls for development by UAN of collective bargaining language for members including provisions for temporary and permanent light-duty assignments for work-injured nurses. Inclusion of this language underscores the critical need to attend to the plight of nurses disabled by hazardous lifting who have been traditionally expected to just go away.  A two-part strategy, of both nurse injury prevention, and of retention of injured nurses by employers in non-lifting nursing positions, would lead to maximum savings to insurers and employers of financial and human resources, as well as saving our country's precious supply of nurses. It is clearly time to quit squandering nurses to preventable disabling injuries.

For complete wording of the resolution, see http://www.uannurse.org/who/resolution/2006/08.html.

See following below for UAN's announcement "UAN, Affiliates Tackle Safe Lifting and Moving" which is available online at http://www.uannurse.org/read/index.html.

Anne Hudson, RN, BSN
anne@wingusa.org
www.wingusa.org Work Injured Nurses' Group USA
June 20, 2006

UAN, Affiliates Tackle Safe Lifting and Moving

Bedside nursing is one of the most dangerous jobs there is. Yet, some tasks performed by staff nurses are often more hazardous than they need to be. One such task is lifting, moving and repositioning patients--who are increasingly heavier and more immobile.

In Washington State, WSNA [Washington State Nurses Association] and its allies are celebrating the passage of a new law that will reduce injuries to nurses who move patients by requiring the use of mechanical lift devices. The new law, signed by Gov. Christine Gregoire (D) March 22, [2006] requires hospitals to buy lift equipment for use by lift teams [or by nurses] and protects from discipline any employees that refuse to perform heavy lifts.

Building on a call by the 2006 NLA [National Labor Assembly] to make safe handling legislation and activities a priority (see resolution 8-06 on www.UANNurse.org/who/resolution.html), UAN [United American Nurses, AFL-CIO] is tackling this issue from the national level as well. UAN was asked by Rep. John Conyers (D-MI) to draft national legislation to create a federal safe patient handling standard. The bill UAN wrote requires hospitals to establish such a standard and have a safe patient lifting plan, and protects nurses who refuse assignments that are unsafe. UAN is seeking support for the bill from ANA [American Nurses Association] and other unions in the AFL-CIO and the Change to Win federation.

“Unsafe lifting, moving and handling is a growing concern for staff nurses,” said UAN Vice President Ann Converso, RN. “We need a standard that protects nurses who are already on the job and makes bedside nursing safer for future nurses. It’s a problem we’re prepared to address on every level—local contracts, state laws and now federal legislation.”

"UAN, Affiliates Tackle Safe Lifting and Moving." Spring 2006. United American Nurses, AFL-CIO. UAN Activist. Vol. 1, No. 2. Online: http://www.uannurse.org/read/index.html.

Legislative Update on Safe Patient Handling

Greetings to All,

Following below is a rundown of legislative activity in the United States on safe patient handling, including states which have passed and states which have introduced legislation to halt needless injuries to nursing staff, patients, and residents from hazardous manual patient lifting.

Healthcare workers remain among top occupations for work-related musculoskeletal injuries. Safety with patient and resident lifting is a concern which will touch nearly all families at some point and is a bipartisan issue with solid support from both Democrats and Republicans. Legislative initiatives to prevent injuries to nursing staff and to patients and residents across all healthcare settings should not need to wait for the “right” political climate. More needless injuries, and untimely loss of nursing personnel, occur with every passing day.

The states and nation need to intensify legislative efforts now to stop avoidable pain to patients and residents, and breaking the backs of nursing staff, from preventable lifting injuries. Research has proven that no method of manual patient lifting is safe and that mechanical patient-lift equipment prevents injuries. Much of the healthcare industry has not voluntarily provided modern patient-lift equipment and has not developed the workplace climate and culture to support its use. Legislation is, therefore, essential to ensure provision of patient-lift equipment for the safety of healthcare workers and of dependent patients and residents.

Changing from accepting nurse injury as “part of the job” and skin tears and other patient injuries with lifting as inevitable, to embracing safe patient handling with modern lift equipment, will occur as the fallacy of applying body mechanics for safety with patient lifting continues to be dismantled. Additionally, beyond training on operation of mechanical patient-lift equipment, optimal nurse “buy-in” of no-manual-lift policies may be achieved by teaching nurses explicatively how the repetitive lifting of hazardous amounts of weight injures spinal structures over time, often without pain, until “too late” when nurses may find themselves with a severe spinal injury, in intense pain, and quite likely out of a job. This crucial information has been sadly lacking from nursing education.

From the following list of state activity, note that Texas and Washington passed legislation for safe patient handling in 2005 and 2006, respectively. Massachusetts legislation for safe patient handling was introduced in 2004 and continues in the Massachusetts Legislature.  California legislation for safe patient handling, vetoed twice by Governor Arnold Schwarzenegger in 2004 and 2005, has been introduced for the third time, in January and February 2006, into the California Senate and Assembly. Rhode Island and Florida each introduced safe patient handling legislation in February 2006 into both the House and the Senate. New Jersey introduced safe patient handling legislation in March 2006.

Importantly, the safe patient handling laws enacted by both Texas and Washington provide for healthcare workers to refuse to perform patient lifting or movement activities, without fear of reprisal, if they believe in good faith that the activity would expose the healthcare worker or patient to an unacceptable risk of injury. This protection is also included in legislation introduced by several other states.

See the list below for more details and for websites for the complete wording of safe patient handling legislation passed and pending in the various states, which may be used as model language by other states in drafting their legislation.

In addition to the states listed below, there may be other states working toward “safe patient handling-no manual lift” legislation which are not listed. Please email me if you have corrections to the info below or information about other state activity.

Thanks much and best wishes to each of you…Anne

Anne Hudson, RN, BSN
Work Injured Nurses’ Group USA
anne@wingusa.org
May 6, 2006

Safe Patient Handling Legislation Passed:

Texas SB 1525 was signed into law by Governor Rick Perry (R) on June 17, 2005. Texas is the first state in the nation to mandate that hospitals and nursing homes implement policy for safe patient handling and movement programs, restricting “to the extent feasible with existing equipment and aids, of manual patient handling or movement of all or most of a patient’s weight to emergency, life-threatening, or otherwise exceptional circumstances.”
Wording: http://www.capitol.state.tx.us/tlo/79R/billtext/SB01525F.HTM.

Washington HB 1672 was signed into law by Governor Christine Gregoire (D) on March 22, 2006. Washington is the first state to mandate that hospitals provide lift equipment as part of their policy for safe patient handling, with the hospital’s choice of three options for implementation of equipment, and with financial assistance by tax credits for the cost of purchasing lifting equipment and reduced workers’ compensation premiums for hospitals implementing safe patient handling programs.
Wording: http://www.leg.wa.gov/pub/billinfo/2005-06/Pdf/Bills/House%20Passed%20Legislature/1672-S.PL.pdf

Safe Patient Handling Legislation Introduced:

California has introduced for the third time.
CA AB 2532, introduced in 2004, was vetoed on September 22, 2004, by Governor Arnold Schwarzenegger.
Veto message: http://www.leginfo.ca.gov/pub/03-04/bill/asm/ab_2501-2550/ab_2532_vt_20040922.html.

CA SB 363, introduced on February 17, 2005, was vetoed on September 29, 2005.
Wording: http://www.leginfo.ca.gov/pub/bill/sen/sb_0351-0400/sb_363_bill_20050217_introduced.pdf.
History: http://www.leginfo.ca.gov/bilinfo.html.
Veto message: http://www.leginfo.ca.gov/pub/bill/sen/sb_0351-0400/sb_363_vt_20050929.html.

CA SB 1204, “Hospitals: lift teams,” was introduced into the Senate on January 25, 2006. If passed, CA SB 1204 will require all general acute care hospitals to adopt a patient protection and health care worker back and musculoskeletal injury prevention plan including a zero lift policy and lift teams trained on lift equipment.
Wording: http://www.leginfo.ca.gov/pub/bill/sen/sb_1201-1250/sb_1204_bill_20060125_introduced.pdf.
History: http://www.leginfo.ca.gov/pub/bill/sen/sb_1201-1250/sb_1204_bill_20060424_history.html.

CA AB 2716, “Hospitals: lift policies,” was introduced into the Assembly on February 24, 2006. If passed, CA AB 2716 will require every general acute care hospital to include a patient lifting policy as a part of its injury prevention program, including a lifting and transferring process, identifying patients needing lift teams, lifting devices, and lifting equipment.
History: http://www.leginfo.ca.gov/pub/bill/asm/ab_2701-2750/ab_2716_bill_20060417_history.html.
Wording: http://www.leginfo.ca.gov/pub/bill/asm/ab_2701-2750/ab_2716_bill_20060224_introduced.pdf.

Massachusetts HB 2662, filed on December 1, 2004, covers private and public acute care hospitals, rehabilitation and psychiatric facilities, and nursing homes. If passed into law, MA HB 2662 will require that "Each health care facility...shall develop and implement a health care worker back injury prevention plan so that manual lifting of patients be minimized in all cases and eliminated when feasible…[by] utilizing lift teams and lifting devices and equipment."
Wording: http://www.mass.gov/legis/bills/house/ht02pdf/ht02662.pdf.
History: http://www.mass.gov/legis/184history/h02662.htm.

Rhode Island introduced bills into the House and the Senate:
RI SB 2760 was introduced into the Senate on February 14, 2006. If passed, RI SB 2760 will establish the "Safe Patient Handling Act of 2006" requiring licensed health care facilities to “Implement a safe patient handling policy for all shifts and units of the facility that will achieve elimination of manual lifting, transferring, and repositioning of all or most of a patient's weight, except in emergency, life-threatening, or otherwise exceptional circumstances.”
Wording: http://www.rilin.state.ri.us/Billtext/BillText06/SenateText06/S2760.pdf.
History: http://dirac.rilin.state.ri.us/BillStatus/WebClass1.ASP?WCI=BillStatus&WCE=ifrmBillStatus&WCU.

RI HB 7386 was introduced into the House on February 16, 2006.  If passed, RI HB 7386 will establish the "Safe Patient Handling Act of 2006" requiring licensed health care facilities “to replace the manual lifting, transferring, and repositioning of patients with lift teams, mechanical lifting devices, engineering controls, and/or equipment to accomplish these tasks…for elimination of manual lifting, transferring, and repositioning of all or most of a patient's weight, except in emergency, life-threatening, or otherwise exceptional circumstances.”
Wording: http://www.rilin.state.ri.us/Billtext/BillText06/HouseText06/H7386.pdf.
History: http://dirac.rilin.state.ri.us/BillStatus/WebClass1.ASP?WCI=BillStatus&WCE=ifrmBillStatus&WCU.

Florida introduced bills into the House and the Senate:
FL HB 1177, “Patient Handling and Movement Practices,” was filed on February 20, 2006. If passed, FL HB 1177 will require hospitals and nursing homes to implement “a minimal manual lift program…that will eliminate manual lifting, repositioning, and moving of patients…with acquisition of, training with, and deployment of sufficient equipment and aids so that manual lifting, repositioning, or moving all or most of a patient's weight is restricted to emergency, life-threatening, or otherwise exceptional circumstances.”
Wording: http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=_h177__.doc&DocumentType=Bill&BillNumber=1177&Session=2006.
History: http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=33345&.

FL SB 2244, “Patient Handling / Safe Movement,” was filed on February 22, 2006.   If passed, this legislation would have required hospitals and nursing homes to adopt policies for the safe movement of patients and residents. FL SB 2244 died, however, in the Committee on Health Care on May 6, 2006.
Wording: http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=_s2244__.html&DocumentType=Bill&BillNumber=2244&Session=2006.
History: http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=33408&

New Jersey S1758, "Safe Patient Handling Act," was introduced into the Senate on March 21, 2006, calling for licensed health care facilities, and State developmental centers and State and county psychiatric hospitals, to establish safe patient handling programs. Health care facilities are to post their safe patient handling policy in a location easily visible to staff, patients, and visitors; and to “purchase safe patient handling equipment and patient handling aids necessary to carry out the safe patient handling policy.”
Wording: http://www.njleg.state.nj.us/2006/Bills/S2000/1758_I1.PDF.
History: http://www.njleg.state.nj.us/bills/BillView.asp.

Other legislation related to safe patient handling:

Ohio HB 67 was signed into law on March 21, 2005, by Governor Bob Taft (R), with Section 4121.48 creating a bureau of workers’ compensation long-term care loan fund “to make loans without interest to…nursing homes…to purchase, improve, install, or erect sit-to-stand floor lifts, ceiling lifts, other lifts, and fast electric beds, and to pay for the education and training of personnel, in order to implement a facility policy of no manual lifting of residents by employees.”
Wording of OH HB 67, Sec. 4121.48: http://www.legislature.state.oh.us/bills.cfm?ID=126_HB_67_EN.

New York companion bills A07641 and S04929 were introduced in April 2005, and signed into law on October 18, 2005, by Governor George Pataki (R), calling for creation of a two-year study to establish safe-patient-handling programs and collect data on the incidence of nursing staff and patient injury with patient handling, manual versus lift equipment. Results will be used to describe best practices for improving health and safety of healthcare workers and patients during patient handling.
Wording of NY A07641 / 7641A: http://assembly.state.ny.us/leg/?bn=A07641&sh=t.
History of NY A07641A, “Same as S 4929-A”:    http://assembly.state.ny.us/leg/?bn=A07641.

Wording of NY S04929 / 4929A: http://assembly.state.ny.us/leg/?bn=S04929&sh=t.
History of S04929, “Same as A 7641-A”: http://assembly.state.ny.us/leg/?bn=S04929.

Washington First State to Mandate Patient Lift Equipment:
Revolutionary Legislation Protects Patients,
Removes Hazardous Lifting from Backs of Healthcare Workers

Washington’s pioneering Safe Patient Handling law is the first legislation in the United States to require hospitals to provide mechanical lift equipment for the safe lifting and movement of patients.

Washington House Bill 1672, which passed the House of Representatives 85 to 13 on March 7, 2006, and the Senate 48 to 0 on March 8, 2006, was signed into law by Washington State Governor Christine Gregoire (D) on March 22, 2006. See “Certification of Enrollment, Engrossed Substitute House Bill 1672” at the Washington State Legislature website: http://www.leg.wa.gov/pub/billinfo/2005-06/Pdf/Bills/House%20Passed%20Legislature/1672-S.PL.pdf.

Healthcare workers continually rank among top occupations for work-related musculoskeletal disorders. Washington’s ground-breaking law provides a model for all of the states and the nation to mandate protection of nurses, nursing assistants, and other healthcare workers against injury related to manual patient lifting by the use of modern technology designed for the task.

Significantly, passage of Washington’s Safe Patient Handling law occurred during National Patient Safety Awareness Week, which was March 5-11, 2006. The new law will protect Washington patients from unintentional pain and injuries, such as skin tears, bruising, dislocations, and being dropped, which sometimes occur during attempts to lift and move patients manually.

On a timeline between February 1, 2007, and January 30, 2010, Washington hospitals must take measures including implementation of a safe patient handling policy and acquisition of their choice of either one readily available lift per acute care unit on the same floor, one lift for every ten acute care inpatient beds, or lift equipment for use by specially trained lift teams.

The new law also provides for hospital employees to refuse to perform, without fear of reprisal, patient handling or movement which the employee believes in good faith would expose a patient or employee to an unacceptable risk of injury.

Hospitals will be assisted financially with implementation of safe patient handling programs by reduced workers’ compensation premiums and tax credits covering the cost of purchasing mechanical lifting or other patient handling devices.

Complete wording of WA HB 1672 follows below.

Anne Hudson, RN, BSN
March 24, 2006
anne@wingusa.org
www.wingusa.org Work Injured Nurses’ Group USA

http://www.leg.wa.gov/pub/billinfo/2005-06/Pdf/Bills/House%20Passed%20Legislature/1672-S.PL.pdf

ENGROSSED SUBSTITUTE HOUSE BILL 1672

Passed Legislature - 2006 Regular Session

State of Washington 59th Legislature 2006 Regular Session

By House Committee on Commerce & Labor (originally sponsored by Representatives Conway, Hudgins, Green, Cody, Appleton, Morrell,Wood, McCoy, Kenney, Moeller and Chase)

READ FIRST TIME 02/03/06.

     AN ACT Relating to reducing injuries among patients and health care workers; adding a new section to chapter 70.41 RCW; adding a new section to chapter 72.23 RCW; adding a new section to chapter 51.16 RCW; adding a new section to chapter 82.04 RCW; and creating a new section.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

     NEW SECTION. Sec. 1. The legislature finds that:
     (1) Patients are not at optimum levels of safety while being lifted, transferred, or repositioned manually. Mechanical lift programs can reduce skin tears suffered by patients by threefold. Nurses, thirty-eight percent of whom have previous back injuries, can drop patients if their pain thresholds are triggered.

     (2) According to the bureau of labor statistics, hospitals in Washington have a nonfatal employee injury incidence rate that exceeds the rate of construction, agriculture, manufacturing, and transportation.

     (3) The physical demands of the nursing profession lead many nurses to leave the profession. Research shows that the annual prevalence rate for nursing back injury is over forty percent and many nurses who suffer a back injury do not return to nursing. Considering the present nursing shortage in Washington, measures must be taken to protect nurses from disabling injury.

     (4) Washington hospitals have made progress toward implementation of safe patient handling programs that are effective in decreasing employee injuries. It is not the intent of this act to place an undue financial burden on hospitals.

     NEW SECTION. Sec. 2. A new section is added to chapter 70.41 RCW to read as follows:
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Lift team" means hospital employees specially trained to conduct patient lifts, transfers, and repositioning using lifting equipment when appropriate.
     (b) "Safe patient handling" means the use of engineering controls, lifting and transfer aids, or assistive devices, by lift teams or other staff, instead of manual lifting to perform the acts of lifting, transferring, and repositioning health care patients and residents.
     (c) "Musculoskeletal disorders" means conditions that involve the nerves, tendons, muscles, and supporting structures of the body.

(2) By February 1, 2007, each hospital must establish a safe patient handling committee either by creating a new committee or assigning the functions of a safe patient handling committee to an existing committee. The purpose of the committee is to design and recommend the process for implementing a safe patient handling program. At least half of the members of the safe patient handling committee shall be frontline nonmanagerial employees who provide direct care to patients unless doing so will adversely affect patient care.

     (3) By December 1, 2007, each hospital must establish a safe patient handling program. As part of this program, a hospital must:

   (a) Implement a safe patient handling policy for all shifts and units of the hospital. Implementation of the safe patient handling policy may be phased-in with the acquisition of equipment under subsection (4) of this section;
     (b) Conduct a patient handling hazard assessment. This assessment should consider such variables as patient-handling tasks, types of nursing units, patient populations, and the physical environment of patient care areas;
     (c) Develop a process to identify the appropriate use of the safe patient handling policy based on the patient's physical and medical condition and the availability of lifting equipment or lift teams. The policy shall include a means to address circumstances under which it would be medically contraindicated to use lifting or transfer aids or assistive devices for particular patients;
     (d) Conduct an annual performance evaluation of the program to determine its effectiveness, with the results of the evaluation reported to the safe patient handling committee. The evaluation shall determine the extent to which implementation of the program has resulted in a reduction in musculoskeletal disorder claims and days of lost work attributable to musculoskeletal disorder caused by patient handling, and include recommendations to increase the program's effectiveness; and
     (e) When developing architectural plans for constructing or remodeling a hospital or a unit of a hospital in which patient handling and movement occurs, consider the feasibility of incorporating patient handling equipment or the physical space and construction design needed to incorporate that equipment at a later date.

     (4) By January 30, 2010, each hospital must complete, at a minimum, acquisition of their choice of: (a) One readily available lift per acute care unit on the same floor unless the safe patient handling committee determines a lift is unnecessary in the unit; (b) one lift for every ten acute care available inpatient beds; or (c) equipment for use by lift teams. Hospitals must train staff on policies, equipment, and devices at least annually.

(5) Nothing in this section precludes lift team members from performing other duties as assigned during their shift.

(6) A hospital shall develop procedures for hospital employees to refuse to perform or be involved in patient handling or movement that the hospital employee believes in good faith will expose a patient or a hospital employee to an unacceptable risk of injury. A hospital employee who in good faith follows the procedure developed by the hospital in accordance with this subsection shall not be the subject of disciplinary action by the hospital for the refusal to perform or be involved in the patient handling or movement.

     NEW SECTION. Sec. 3. A new section is added to chapter 72.23 RCW to read as follows:
     (1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
     (a) "Lift team" means hospital employees specially trained to conduct patient lifts, transfers, and repositioning using lifting equipment when appropriate.
     (b) "Safe patient handling" means the use of engineering controls, lifting and transfer aids, or assistive devices, by lift teams or other staff, instead of manual lifting to perform the acts of lifting, transferring, and repositioning health care patients and residents.
     (c) "Musculoskeletal disorders" means conditions that involve the nerves, tendons, muscles, and supporting structures of the body.
     (2) By February 1, 2007, each hospital must establish a safe patient handling committee either by creating a new committee or assigning the functions of a safe patient handling committee to an existing committee. The purpose of the committee is to design and recommend the process for implementing a safe patient handling program.  At least half of the members of the safe patient handling committee shall be frontline nonmanagerial employees who provide direct care to patients unless doing so will adversely affect patient care.
     (3)  By December 1, 2007, each hospital must establish a safe patient handling program. As part of this program, a hospital must:
     (a) Implement a safe patient handling policy for all shifts and units of the hospital. Implementation of the safe patient handling policy may be phased-in with the acquisition of equipment under subsection (4) of this section;
     (b) Conduct a patient handling hazard assessment. This assessment should consider such variables as patient-handling tasks, types of nursing units, patient populations, and the physical environment of patient care areas;
     (c) Develop a process to identify the appropriate use of the safe patient handling policy based on the patient's physical and medical condition and the availability of lifting equipment or lift teams;
     (d) Conduct an annual performance evaluation of the program to determine its effectiveness, with the results of the evaluation reported to the safe patient handling committee.  The evaluation shall determine the extent to which implementation of the program has resulted in a reduction in musculoskeletal disorder claims and days of lost work attributable to musculoskeletal disorder caused by patient handling, and include recommendations to increase the program's effectiveness; and
     (e) When developing architectural plans for constructing or remodeling a hospital or a unit of a hospital in which patient handling and movement occurs, consider the feasibility of incorporating patient handling equipment or the physical space and construction design needed to incorporate that equipment at a later date.

     (4) By January 30, 2010, hospitals must complete acquisition of their choice of: (a) One readily available lift per acute care unit on the same floor, unless the safe patient handling committee determines a lift is unnecessary in the unit; (b) one lift for every ten acute care available inpatient beds; or (c) equipment for use by lift teams.  Hospitals must train staff on policies, equipment, and devices at least annually.

     (5) Nothing in this section precludes lift team members from performing other duties as assigned during their shift.

(6) A hospital shall develop procedures for hospital employees to refuse to perform or be involved in patient handling or movement that the hospital employee believes in good faith will expose a patient or a hospital employee to an unacceptable risk of injury. A hospital employee who in good faith follows the procedure developed by the hospital in accordance with this subsection shall not be the subject of disciplinary action by the hospital for the refusal to perform or be involved in the patient handling or movement.

     NEW SECTION. Sec. 4. A new section is added to chapter 51.16 RCW to read as follows:
     (1) By January 1, 2007, the department shall develop rules to provide a reduced workers' compensation premium for hospitals that implement a safe patient handling program. The rules shall include any requirements for obtaining the reduced premium that must be met by hospitals.

(2) The department shall complete an evaluation of the results of the reduced premium, including changes in claim frequency and costs, and shall report to the appropriate committees of the legislature by December 1, 2010, and 2012.

     NEW SECTION. Sec. 5. A new section is added to chapter 82.04 RCW to read as follows:
     (1) In computing the tax imposed under this chapter, a hospital may take a credit for the cost of purchasing mechanical lifting devices and other equipment that are primarily used to minimize patient handling by health care providers, consistent with a safe patient handling program developed and implemented by the hospital in compliance with section 2 of this act. The credit is equal to one hundred percent of the cost of the mechanical lifting devices or other equipment.

(2) No application is necessary for the credit, however, a hospital taking a credit under this section must maintain records, as required by the department, necessary to verify eligibility for the credit under this section. The hospital is subject to all of the requirements of chapter 82.32 RCW. A credit earned during one calendar year may be carried over to be credited against taxes incurred in a subsequent calendar year. No refunds shall be granted for credits under this section.

(3) The maximum credit that may be earned under this section for each hospital is limited to one thousand dollars for each acute care available inpatient bed.

(4) Credits are available on a first in-time basis. The department shall disallow any credits, or portion thereof, that would cause the total amount of credits claimed statewide under this section to exceed ten million dollars. If the ten million dollar limitation is reached, the department shall notify hospitals that the annual statewide limit has been met. In addition, the department shall provide written notice to any hospital that has claimed tax credits after the ten million dollar limitation in this subsection has been met. The notice shall indicate the amount of tax due and shall provide that the tax be paid within thirty days from the date of such notice. The department shall not assess penalties and interest as provided in chapter 82.32 RCW on the amount due in the initial notice if the amount due is paid by the due date specified in the notice, or any extension thereof.