CA law calls for hospital lift teams

Seven states require safe pt handling

Lift teams are now the law in California. After seven years and five vetoes, a safe patient handling bill was signed by Gov. Jerry Brown that requires hospitals to have "trained lift teams or other support staff trained in safe lifting techniques."

California joins seven other states that have laws requiring hospitals to maintain a safe patient handling program. "We are extremely pleased that nurses and patients and health care workers are going to be safer in California," says Bonnie Castillo, RN, government relations director of the California Nurses Association in Sacramento, which sponsored the legislation.

While many hospitals have developed minimal-lift programs, the adoption of safe patient handling across the nation varies widely. The U.S. Bureau of Labor Statistics reported that the incidence rate of musculoskeletal disorders requiring days away from work rose by 5% among nurses in 2009, although it dropped by 5% in private industry overall.

Hospitals have a rate of overexertion due to lifting that is about double the rate for general industry (24.5 per 10,000 fulltime equivalent workers, compared to 12.8 in private industry).

As many as 20 states have discussed proposals for encouraging or requiring safe patient handling in health care, but the issue has failed to get traction nationally. Congress did not act on a bill that would have required safe patient handling programs and would have provided $200 million in grants to health care facilities to purchase lift equipment.

"We're looking for California's success to be that spark for renewed effort for the nation," says Anne Hudson, RN, a back-injured nurse from Coos Bay, OR, who founded WING USA (Work Injured Nurses' Group), which lobbied for the legislation.

RNs coordinate lifts

The path to the California law was not an easy one. A safe patient handling bill first passed the California legislature in 2004, but it was repeatedly vetoed by then Gov. Arnold Schwarzenegger. He said the law was unnecessary, and he expressed concern about the financial burden on hospitals and the need for flexibility.

The new law applies only to hospitals. It requires employers to maintain a "patient protection and health care worker back and musculoskeletal injury prevention plan." Registered nurses assess patient lift needs and oversee the lifts: "As coordinator of care, the registered nurse shall be responsible for the observation and direction of patient lifts and mobilization, and shall participate as needed in patient handling in accordance with the nurse's job description and professional judgment."

Nurses care for designated patients and because of staffing ratios they can't necessarily help other nurses with lifts, says Castillo. That's why the hospital needs to assign trained staff to help with lifts, she says.

"It's based on the RN assessment with regards to what is needed and required for each particular lift," she says. "What's important is that the hospital maintains at all times adequate numbers of personnel who are trained and have the up to date safe equipment to do the more complex lifts."

The California Hospital Association opposed the bill. It didn't provide enough flexibility for hospitals that have different patient populations and lift needs — such as pediatric hospitals or units or neonatal units, says spokeswoman Jan Emerson-Shea.

"We don't believe a one-size-fits-all approach is the right way to address the issue," she says. The issue is real, and hospitals have been working on it for a number of years."

Hospitals also were concerned about the bill's restriction on disciplining employees who refuse to assist with a lift, she says. The law states: "A health care worker who refuses to lift, reposition, or transfer a patient due to concerns about patient or worker safety or the lack of trained lift team personnel or equipment shall not, based upon the refusal, be the subject of disciplinary action by the hospital or any of its managers or employees."

States have taken very different approaches to safe patient handling. Texas, the first state to pass a law on the subject, requires hospitals to have safe patient handling programs but doesn't mandate the use of lift equipment. In 2006, Washington was the first state to require the use of lift equipment. The state also provided financial assistance to purchase equipment through tax credits.

Minnesota followed in 2007 with a similar law and grant fund. Ohio provided an interest-free loan fund for nursing homes to purchase lift equipment.

The California law has a glaring omission because it does not apply to nursing homes, where back injuries from patient lifting are even more common than in hospitals. It simply wasn't politically possible to get a more encompassing bill, says Castillo.

Meanwhile, efforts will continue for a national safe patient handling law, says Hudson. She hopes to enlist bipartisan support for a comprehensive approach. "[This] highlights the need for a national standard to cover all health care workers across all health care settings," she says.