Landmark law requires Washington hospitals to buy lift equipment  

$10 million fund supports purchase of one lift per 10 beds

Washington has become the first state in the nation to require hospitals to use patient transfer equipment “instead of manual lifting” as part of a safe patient handling program. The law, which easily passed the state House and Senate, with support from unions and the hospital association, is a landmark for the safe patient handling movement.

As other states consider measures to promote safe patient handling, health care worker advocates draw a parallel with the state-by-state campaign that led to a national needlestick prevention law.

“Momentum is building,” says Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU). “This is synonymous with the first safer needle law we got passed in California in ’98 that led to the federal law in 2000, after we passed 20 state laws.

“A very similar scenario is playing out here,” he continues. “Hopefully, this won’t take as long when enlightened employers realize how cost-effective these programs are.”

Last year, Texas passed a law requiring hospitals to implement a safe patient handling program. Although it doesn’t require the use of lifts or other devices, hospitals there have begun purchasing more ergonomic equipment, Borwegen says.

The Rhode Island, Florida, New Jersey, and Massachusetts legislatures also considered safe patient handling bills this year. A 2005 Ohio law provides no-interest loans to nursing home employers to pay for patient handling equipment and training, and a New York law established a voluntary two-year pilot project.

The Washington legislation differs from other efforts in one important way: It provides financial compensation to hospitals for purchasing patient transfer devices.

The law establishes a $10 million fund to provide a tax credit of up to $1,000 per bed to compensate for the expense of new equipment, and it directs the state’s workers’ compensation fund to reduce insurance premiums for hospitals that implement the safe patient handling program.

That financial compensation, along with some wording changes, influenced the Washington State Hospital Association (WSHA) to support the legislation.

“We’re the first state in the nation that provided funding for hospitals,” says Cassie Sauer, the association’s director of advocacy and public relations, noting that lift equipment is an expensive investment. “State legislatures around the country continue to pass unfunded mandates for hospitals.”

Ergonomics regulations have a long, rocky history, but focusing solely on patient handling has been a successful strategy for health care worker unions.


“This is the ultimate low-hanging fruit,” says Borwegen. “There are studies that show facilities save up to $10 for every $1 they invest in these programs. These are the most cost-effective ergonomic interventions that I’m aware of.”

The U.S. Occupational Safety and Health Administration issued an ergonomics standard in 2000, but Congress rescinded the rule months later. Washington state developed a comprehensive ergonomics rule in 2002, which required employers to identify “caution zone jobs” and to reduce the hazards of musculoskeletal disorder injuries. Lifting 75 pounds or more once a day would have qualified as a caution zone job, which means hospitals would have been required to reduce the hazards of patient handling.

In a 2003 ballot initiative, Washington voters rescinded the ergonomics rule, which was strongly opposed by a coalition of businesses.

“They made it sound like if you supported ergonomics, you were in favor of people losing their health insurance. All these jobs would be leaving Washington state and people would be on the street without health insurance,” recalls Carter Wright, communications director of SEIU 1199 Northwest in Seattle.

“It was much harder to distort the reality of what the problem is for health care workers,” he says. “We had a really remarkable number of members of our union get involved in a really personal way [by contacting legislators].”

 A mandate with money

The turning point for Washington’s safe patient handling law came when the WSHA switched from opposing to supporting it. Wording was changed; so rather than requiring a “no manual lift” policy, the law requires a “safe patient handling policy.”

That ensures that equipment wouldn’t be required for patients who don’t need it, such as infants or those who may be too vulnerable to injury, such as hip replacement patients, says Sauer. “The first version was too open-ended. It said hospitals would have to purchase needed equipment but didn’t say what the equipment would be.”

The final version requires one “readily available” lift per acute care unit, unless the safe patient handling committee determines a lift is not necessary, or one lift per every 10 acute care inpatient beds, or equipment for use by a lift team.

Most importantly, the bill provided the $10 million equipment fund. “This needs to be something that the state is investing in,” says Sauer. The bill passed the state Senate unanimously and the House by a margin of 85-13 and was signed by Gov. Chris Gregoire on March 22.

The hospital association and Washington State Nurses Association will provide education about the bill and safe patient handling to help health care workers change their habits and learn to use the equipment, she says.

The bill affects the state’s 98 hospitals and numerous nursing homes. “We believe that at least a third [of the state’s hospitals] would already be complying with the mandate and probably [doing] more,” says Sauer.


1. Stubbs DA, Buckle PW, Hudson MP, et al. Backing out: Nurse wastage associated with back pain. Int J Nurs Stud 1986; 23(4): 325-336.

Washington law requires safe patient handling 

According to the Washington safe patient handling law, hospitals must:

  • Create a safe patient handling committee by Feb. 1, 2007. They may assign the duties to an existing committee. At least half the committee members must be “frontline nonmanagerial employees who provide direct care to patients unless doing so will adversely affect patient care.”
  • Establish a safe patient handling program by Dec. 1, 2007, which includes a safe patient handling policy for all shifts and units.
  • Conduct a patient handling hazard assessment that considers “patient handling tasks, types of nursing units, patient populations, and the physical environment of patient care areas.”
  • Develop a method 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.” That includes circumstances in which certain devices would be medically contraindicated for particular patients.
  • Purchase equipment by Jan. 30, 2010, that meets the minimum standards of 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; one lift for every 10 acute care available inpatient beds; or equipment for use by lift teams.”
  • Train hospital staff at least annually on policies, equipment, and devices.
  • Evaluate the program annually, including its impact on musculoskeletal disorder injuries.
  • Consider safe patient handling needs in architectural plans for construction or remodeling of a facility.
  • Develop policies and procedures that allow an employee 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.”