Ergonomic efforts move to the states

Texas first to require program

Texas has become the first state to require safe patient handling programs in hospitals. That milestone has captured national attention as other states consider their own versions of a safe patient handling mandate.

The state's activity echoes the early days of the needle safety movement, which started in California and swept through state legislatures until it gained national momentum, resulting in a federal law. Could that happen again with patient handling?

"Obviously, we would love for that to occur," says Sue Whittaker, RN, MSN, associate director of state government relations for the American Nurses Association (ANA) in Silver Spring, MD. ANA still would like to see a federal regulation, but that seems a distant hope. Both a Washington state and an Occupational Health and Safety Administration standard were rescinded, she notes. "For us, this was the way to go."

Texas may seem an unlikely state to be the standard bearer for a new worker safety requirement, but concern over nurses' injuries and the nursing shortage brought the Texas Nurses Association and the Texas Hospital Association together.

"We want to make sure hospitals and nursing homes are paying attention to the fact that it is important to retain the nurses we have," says Jennifer Banda, JD, director of governmental affairs for the Texas Hospital Association in Austin. "Our nursing shortage in Texas is at a crisis level."

The nurses association previously had worked with the hospital association to lobby for more funding for nursing schools and nurse staffing. That relationship made it easier to reach agreement on patient handling, says James Willmann, JD, general counsel and director of governmental affairs for the Texas Nurses Association, also in Austin.

"It wasn't going to be sufficient to just address the supply of nurses unless you addressed some of the work force issues they had," he says.

Hospital must assess risk of injury

Under the new law, as of Jan. 1, 2006, hospitals in Texas will be required "to identify, assess, and develop strategies to control risk of injury to patients and nurses associated with the lifting, transferring, repositioning, or movement of a patient."

The law actually doesn't require the use of equipment or the purchase of new equipment, but it says the hospital's policy must include "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."

Hospitals must analyze risks to patients and nurses and educate nurses about the risks.

They also must have "procedures for nurses to refuse to perform or be involved in patient handling or movement that the nurse believes in good faith will expose a patient or a nurse to an unacceptable risk of injury."

The law requires an annual report on patient handling activities to the nurse staffing committee and the hospital's governing body or quality assurance committee. Construction or remodeling of a hospital or nursing home also must involve a consideration of patient handling equipment.

"We really do believe that if we can get the hospitals and nursing homes to seriously look at this issue — and the legislation forces them to look at it — it will translate into some results," Willmann says.

The Texas law reflects some political realities. It mentions only nurses, although its supporters hope and expect that hospitals will create a broader policy and program that includes other health care workers.

It doesn't require the purchase of equipment. "We agreed we would not mandate that by some certain date we'd have to eliminate manual lifting," Willmann notes.

"You'd probably have to have an exception for small rural hospitals. They'd say, ‘We'll just close our doors.' Well, that's not an option in rural Texas," he says.

Willmann points out that a bill in California requiring hospitals to use lift teams and equipment to reduce patient handling injuries was vetoed by the governor.

"We went into this believing that hospitals will operate in good faith," Willmann says. "If they're going to be required to develop policies, most of them are going to develop policies that make good sense."

Meanwhile, other states have fashioned legislation to promote safe patient handling. The New York legislature authorized a two-year study of safe patient handling programs. "Hopefully, it will raise awareness in health care institutions and elsewhere about how critical this issue is," Whittaker adds.

Ohio provided interest-free loans to long-term care facilities that implement a "no manual lift" program. The loans are targeted for equipment and employee training. Savings from the reduction in injuries could be used to repay the loans, she explains.

California, Iowa, Massachusetts, Minnesota, New Jersey, and Washington also considered safe patient handling legislation this year.

The Texas Hospital Association has been promoting the new safe patient handling law, educating CEOs, and touting its benefits — not just for nurses, but for patients, too.

"Overall, we're getting a positive response," Banda continues. "Hospitals realize that we want to do something to have a positive impact on the work force in the hospitals. This is a very good first step in working with the nursing work force."

The ANA has emphasized patient handling with its Handle with Care campaign. These new state laws are just a beginning, Whittaker points out.

"Until we can take nurses off the list as one of the higher professions being injured, then we have a lot of work to do," she explains. "We know what causes it, and we know what prevents it."