State licensing rules call for safe lifts

States put teeth into safe lift laws

As safe patient handling laws gain ground in state legislatures, reducing injuries is becoming the mandate of a new enforcement power: the state licensing division.

"If there ever was a question about the importance of this particular law, there isn't any more," says Elizabeth Sjoberg, RN, JD, associate general counsel for the Texas Hospital Association in Austin, where the state legislature passed a safe patient handling law in 2005. It became effective Jan. 1, 2006.

Texas was the first state to require hospitals to create a safe patient handling program. Although the law doesn't require the use of equipment, hospitals have been purchasing equipment as part of their programs, she says.

Meanwhile, to keep pace with the law, the Texas Department of State Health Services has created a new licensing rule that requires hospitals to implement and enforce their safe patient handling policies.

"They want to be sure that any type of policy that hospitals develop is implemented and enforced," says Sjoberg. "It does add great strength to the law that was passed [almost] two years ago."

Washington and Rhode Island also have passed safe patient handling laws that incorporate the requirements in state licensing rules. "It becomes part of the standard of practice, just like anything else," says Brenda Suiter, MHA, director of rural and public health for the Washington State Hospital Association. "It's just part of how care is provided in the facility."

Meanwhile, health care worker advocates are pressing for a national law. U.S. Rep. John Conyers (D-MI) introduced a safe patient handling bill in the late fall. No action was taken on it before Congress recessed for the November elections.

"Health care workers have more [work-related musculoskeletal disorder] injuries than anybody else in the country," says Anne Hudson, RN, an injured nurse from Coos Bay, OR, who formed the Work Injured Nurses' Group (WING USA) to advocate for injured nurses and support safe patient handling efforts. "There has to be a more direct and forceful effort to stop all these injuries."

TX nurses work with rural hospitals

Safe patient handling is better for patients, saves hospitals money, and is needed to preserve the nursing work force. That is the compelling argument used in states that have passed the legislation. Existing laws also avoid mandating a "no-lift" environment or the use of lift teams. (Legislation requiring "zero-lift" policies in California has been vetoed three times by Gov. Arnold Schwarzenegger, who called it "a rigid, one-size-fits-all mandate.")

In successful states, the hospital association and unions have worked together to create acceptable language. The Texas law, for example, was not proscriptive, but it established a framework and expectation, says Claire Jordan, RN, MSN, executive director of the Texas Nurses Association in Austin.

"While it doesn't mandate, it certainly gives [hospitals] the guidelines of what they need to have in place to be in line with their peers," she says.

For example, the Texas law requires hospitals have a safe patient handling policy that includes "an evaluation of alternative ways to reduce risks associated with patient handling, including evaluation of equipment and the environment," and a "restriction, 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."

TNA has adapted a safe patient handling curriculum and provided it to the state's 90 nursing schools. The group also designates hospitals as "nurse-friendly" if they meet 12 requirements, including having a safe patient handling program with lift equipment. TNA worked with 20 rural hospitals to help them attain that designation.

WA hospitals get tax credits

Washington state included a unique enticement in its law, which set aside $10 million for hospitals to obtain tax credits for buying patient lift and transfer equipment.

The law requires hospitals to have a minimal level of lift equipment, and provides a tax credit of up to $1,000 for every available inpatient bed, explains Suiter.

Hospitals that already had a zero-lift policy were able to take advantage of the tax credits immediately, she says.

Yet even hospitals with safe patient handling programs may need to make changes to comply with the law. By Feb. 1, 2007, they must have a safe patient handling committee that includes nonmanagerial, direct-care employees.

"Most hospitals were already working to decrease employee injuries before the law was implemented," Suiter says. "They know the importance of a healthy work force."

But for those hospitals in which safety officers and employee health professionals struggled for administrative support, the law gives safe patient handling a higher profile. "This has provided a lot more attention and resources so they're able to more effectively do their jobs," says Suiter.

Goal is a national law

Health care worker advocates seek additional safe patient handling laws in other states. But ultimately, they hope the state actions will lead to a federal law or standard, as with the Needlestick Safety and Prevention Act.

The Nurse and Patient Safety and Protection Act, introduced in Congress, would direct the U.S. Occupational Safety and Health Administration (OSHA) to create a "federal safe patient handling standard." It would require hospitals to "purchase, use, and maintain safe lift mechanical devices" and to "report, track, and analyze trends in injuries, as well as make injury data available to the public."

It also would require OSHA to conduct "unscheduled audits" to ensure compliance with the law.

Because it was introduced late in the congressional session, the prospects for this bill were unclear. But the steady movement toward tougher state standards makes national action more likely, health care worker advocates say.

"We are moving toward a national, no-manual lift [policy] for health care," says Hudson. "We have to. The evidence is piled high in favor of safe patient handling through use of lift equipment."