I 

113TH CONGRESS 

1ST SESSION H. R. 2480 

To direct the Secretary of Labor to issue an occupational safety and health 

standard to reduce injuries to patients, nurses, and all other health 

care workers by establishing a safe patient handling, mobility, and injury 

prevention standard, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 25, 2013 

Mr. CONYERS (for himself and Mr. GEORGE MILLER of California) introduced 

the following bill; which was referred to the Committee on Education and 

the Workforce, and in addition to the Committees on Energy and Commerce and Ways and Means, 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 direct the Secretary of Labor to issue an occupational 

safety and health standard to reduce injuries to patients, 

nurses, and all other health care workers by establishing 

a safe patient handling, mobility, and injury prevention 

standard, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; FINDINGS; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Nurse and Health Care Worker Protection Act of 2013’’. 


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1 (b) FINDINGS.—Congress finds the following: 

2 (1) In 2011, registered nurses ranked fifth 

3 among all occupations for the number of cases of 

4 musculoskeletal disorders resulting in days away 

5 from work, with 11,880 total cases. In 2011, nurs6 ing assistants reported 25,010 cases—the highest of 

7 all occupations. The leading cause of these health 

8 care employees’ injuries is patient lifting, transfer9 ring, and repositioning injuries, which constitute a 

10 significant risk to the health and welfare of those 

11 employees. 

12 (2) The physical demands of the nursing pro13 fession lead many nurses to leave the profession. 

14 Fifty-two percent of nurses complain of chronic back 

15 pain and 38 percent suffer from pain severe enough 

16 to require leave from work. Many nurses and other 

17 health care workers suffering back injury do not re18 turn to work. These consequences constitute a mate19 rial impairment of health for these employees. 

20 (3) Patients are not at optimum levels of safety 

21 while being lifted, transferred, or repositioned manu22 ally. Mechanical and other appropriate lift programs 

23 can substantially reduce skin tears and pressure ul24 cers suffered by patients and the frequency of paVerDate Mar 15 2010 03:33 Jun 27, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2480.IH H2480

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1 tients being dropped, thus allowing patients a safer 

2 means to progress through their care. 

3 (4) The development of assistive patient han4 dling technology, equipment, and devices has essen5 tially rendered the act of strict manual patient han6 dling outdated and typically unnecessary as a func7 tion of nursing care. 

8 (5) A growing number of health care facilities 

9 that have incorporated patient handling technology 

10 and practices have reported positive results. Injuries 

11 among nursing staff and health care workers have 

12 dramatically declined at health care facilities imple13 menting safe patient handling technology, equip14 ment, devices, and practices. As a result, the number 

15 of lost work days due to injury and staff turnover 

16 has declined. Studies have also shown that assistive 

17 patient handling technology successfully reduces 

18 workers’ compensation costs for musculoskeletal dis19 orders. 

20 (6) A number of States have implemented safe 

21 patient handling, mobility and injury prevention 

22 standards. The success of these programs at the fa23 cility and State level demonstrates the feasibility of 

24 such standards. 


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1 (7) Establishing a safe patient handling, mobil2 ity, and injury prevention standard for direct-care 

3 registered nurses and other health care workers is a 

4 critical component reasonably necessary for pro5 tecting the health and safety of nurses and other 

6 health care workers, addressing the nursing short7 age, and increasing patient safety. 

8 (c) TABLE OF CONTENTS.—The table of contents of 

9 this Act is as follows: 

Sec. 1. Short title; findings; table of contents. 

Sec. 2. Safe patient handling, mobility, and injury prevention standard. 

Sec. 3. Application of safe patient handling, mobility, and injury prevention 

standard to facilities receiving Medicare and Medicaid funds. 

Sec. 4. Nonpreemption. 

Sec. 5. Definitions. 

10 SEC. 2. SAFE PATIENT HANDLING, MOBILITY, AND INJURY 

11 PREVENTION STANDARD. 

12 (a) RULEMAKING.—Notwithstanding any other provi13 sion of law, not later than 1 year after the date of enact14 ment of this Act, the Secretary of Labor shall, pursuant 

15 to section 6 of the Occupational Safety and Health Act 

16 of 1970 (29 U.S.C. 655), promulgate an interim final 

17 standard on safe patient handling, mobility, and injury 

18 prevention (in this section such standard is referred to as 

19 the ‘‘safe patient handling, mobility, and injury prevention 

20 standard’’) to prevent musculoskeletal disorders for direct21 care registered nurses and all other health care workers 

22 handling patients. A final safe patient handling, mobility, 


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1 and injury prevention standard shall be promulgated not 

2 later than 2 years after the date of enactment of this Act. 

3 (b) REQUIREMENTS.—The safe patient handling, mo4 bility, and injury prevention standard shall require the use 

5 of engineering and safety controls to perform handling of 

6 patients and the elimination of injuries from manual han7 dling of patients by direct-care registered nurses and all 

8 other health care workers, through the development of a 

9 comprehensive program, to include the use of mechanical 

10 technology and devices to the greatest degree feasible. 

11 Where the use of mechanical technology and devices is not 

12 feasible, the standards shall require the use of alternative 

13 controls and measures, including trained, designated lift 

14 teams, to minimize the risk of injury to nurses and health 

15 care workers resulting from the manual handling of pa16 tients. The standard shall apply to all health care employ17 ers, shall generally align with interprofessional national 

18 safe patient handling, mobility, and injury prevention 

19 standards, and shall include the following: 

20 (1) PROGRAM DEVELOPMENT.—A requirement 

21 that each health care employer shall develop and im22 plement a safe patient handling, mobility, and injury 

23 prevention program within 6 months of the date of 

24 promulgation of the final standard, which program 

25 shall include hazard identification, risk assessments, 


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1 and control measures in relation to patient care du2 ties and patient handling. 

3 (2) TECHNOLOGY AND EQUIPMENT PURCHASE

4 AND MANAGEMENT.—A requirement that, within 2 

5 years of the date of promulgation of the final stand6 ard, each health care employer shall purchase, use, 

7 maintain, and make accessible to health care work8 ers, such safe patient handling equipment, tech9 nology, and accessories as the Secretary determines 

10 appropriate. 

11 (3) HEALTH CARE WORKER PARTICIPATION.—A 

12 requirement that each health care employer shall ob13 tain input from health care workers, to include di14 rect care registered nurses, health care workers, 

15 their representatives, and their collective bargaining 

16 agents, in developing and implementing the safe pa17 tient handling, mobility, and injury prevention pro18 gram, including the purchase of technology and 

19 equipment and necessary accessories. 

20 (4) DATA TRACKING AND REVIEW.—A require21 ment that each health care employer shall establish 

22 a review program to analyze data relevant to the im23 plementation of the employers’ safe patient handling, 

24 mobility, and injury prevention program, and shall 

25 account for circumstances where safe patient hanVerDate Mar 15 2010 03:33 Jun 27, 2013 Jkt 029200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2480.IH H2480

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1 dling technology and equipment, or trained, des2 ignated lift teams, were not utilized in accordance 

3 with the health care employers safe patient handling, 

4 mobility, and injury prevention standard. Each 

5 health care employer shall upon request, make avail6 able their findings and data used in such review, to 

7 health care workers, their representatives, their col8 lective bargaining agents, and the Secretary or other 

9 Federal agency. 

10 (5) INCORPORATION OF TECHNOLOGY INTO FA11 CILITIES.—A requirement that each health care em12 ployer shall consider the feasibility of incorporating 

13 safe patient handling technology as part of process 

14 of new facility design and construction, or facility re15 modeling. 

16 (6) EDUCATION AND TRAINING.—A require17 ment that each health care employer shall train 

18 health care workers on safe patient handling, mobil19 ity, and injury prevention policies, technology, equip20 ment, and devices, initially, and on a continuing an21 nual basis, and as necessary. Such training shall 

22 prepare health care workers, including designated 

23 lift teams, to identify, assess, and control musculo24 skeletal hazards of a general nature, and those spe25 cific to particular patient care areas, and shall be 


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1 conducted by an individual with knowledge in the 

2 subject matter, and delivered, at least in part, in an 

3 interactive simulated point-of-care training and 

4 hands-on format that reflects the specific demands 

5 of a health care workers’ duties. 

6 (7) NOTICE OF SAFE PATIENT HANDLING AND

7 RIGHTS UNDER THIS ACT.—A requirement that each 

8 health care employer shall post a uniform notice in 

9 a form specified by the Secretary that— 

10 (A) explains the safe patient handling, mo11 bility, and injury prevention standard; 

12 (B) includes information regarding safe 

13 patient handling, mobility, and injury preven14 tion policies and training; 

15 (C) explains procedures to report patient 

16 handling-related injuries; and 

17 (D) explains health care workers’ rights 

18 under this Act. 

19 (8) ANNUAL EVALUATION.—A requirement that 

20 each health care employer shall conduct an annual 

21 written evaluation of the implementation of the safe 

22 patient handling, mobility, and injury prevention 

23 program, including handling procedures, selection of 

24 technology, equipment, and engineering controls, as25 sessment of injuries, and new safe patient handling, 


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1 mobility, and injury prevention technology and de2 vices that have been developed. The evaluation shall 

3 be conducted with the involvement of nurses, other 

4 health care workers, their representatives, and their 

5 collective bargaining agents, and their input shall be 

6 documented in the evaluation. Health care employers 

7 shall take corrective action as recommended in the 

8 written evaluation. 

9 (9) RIGHT TO REFUSE UNSAFE ASSIGNMENT.— 

10 A requirement that each health care employer shall 

11 provide procedures under which a health care worker 

12 or employee may refuse to perform the employee’s 

13 duties if the employee has a reasonable apprehension 

14 that performing such duties would violate the safe 

15 patient handling, mobility, and injury prevention 

16 standard, and would result in injury or impairment 

17 of health to the health care worker, other health 

18 care workers, or patients. Where practicable, the 

19 health care worker must have communicated the 

20 health or safety concern to the health care employer 

21 and have not been able to obtain a correction of the 

22 violation. 

23 (c) INSPECTIONS.—The Secretary of Labor shall con24 duct unscheduled inspections under section 8 of the Occu25 pational Safety and Health Act of 1970 (29 U.S.C. 657) 


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1 to ensure implementation of and compliance with the safe 

2 patient handling, mobility, and injury prevention stand3 ard. 

4 SEC. 3. APPLICATION OF SAFE PATIENT HANDLING, MOBIL5 ITY, AND INJURY PREVENTION STANDARD TO 

6 FACILITIES RECEIVING MEDICARE AND MED7 ICAID FUNDS. 

8 (a) IN GENERAL.—Section 1866 of the Social Secu9 rity Act (42 U.S.C. 1395cc) is amended— 

10 (1) in subsection (a)(1)(V), by inserting ‘‘and 

11 safe patient handling, mobility, and injury preven12 tion standard (as initially promulgated under section 

13 2 of the Nurse and Health Care Worker Protection 

14 Act of 2009)’’ before the period at the end; and 

15 (2) in subsection (b)(4)— 

16 (A) in subparagraph (A), inserting ‘‘and 

17 the safe patient handling, mobility, and injury 

18 prevention standard’’ after ‘‘Bloodborne Patho19 gens standard’’; and 

20 (B) in subparagraph (B), inserting ‘‘or the 

21 safe patient handling, mobility, and injury pre22 vention standard’’ after ‘‘Bloodborne Pathogens 

23 standard’’. 

24 (b) EFFECTIVE DATE.—The amendments made by 

25 subsection (a) shall apply to health care facilities 1 year 


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1 after date of issuance of the final safe patient handling, 

2 mobility, and injury prevention standard required under 

3 section 2. 

4 SEC. 4. NONPREEMPTION. 

5 (a) EFFECT ON OTHER LAWS.—Nothing in this Act 

6 shall be construed to— 

7 (1) preempt any law, rule, or regulation of a 

8 State or political subdivision of a State, unless such 

9 law, rule, or regulation is in conflict with this Act 

10 or a regulation or order issued under this Act; or 

11 (2) impair or diminish in any way the authority 

12 of any State to enact and enforce any law which pro13 vides equivalent or greater protections for employees 

14 engaging in conduct protected under this Act. 

15 (b) RIGHTS RETAINED BY HEALTH CARE WORK16 ERS.—Nothing in this Act shall be construed to diminish 

17 the rights, privileges, or remedies of any health care work18 er or employee under any Federal or State law, or under 

19 any collective bargaining agreement. 

20 SEC. 5. DEFINITIONS. 

21 For purposes of this Act: 

22 (1) DIRECT-CARE REGISTERED NURSE.—The 

23 term ‘‘direct-care registered nurse’’ means an indi24 vidual who has been granted a license by at least 

25 one State to practice as a registered nurse and who 


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1 provides bedside care or outpatient services for one 

2 or more patients or residents. 

3 (2) EMPLOYEE.—The term ‘‘employee’’ means 

4 any individual employed by a health care employer, 

5 to include health care workers, as well as employees 

6 who do not qualify as health care workers, including 

7 independent contractors. 

8 (3) EMPLOYMENT.—The term ‘‘employment’’ 

9 includes the provision of services under a contract or 

10 other arrangement. 

11 (4) HANDLING.—The term ‘‘handling’’ includes 

12 actions such as lifting, transferring, repositioning, 

13 mobilizing, moving, or any other action involving the 

14 physical movement, manipulation, or support of a 

15 patient by a health care worker, or any direct pa16 tient care action which presents a risk of musculo17 skeletal injury. 

18 (5) HEALTH CARE EMPLOYER.—The term 

19 ‘‘health care employer’’ means an outpatient health 

20 care facility, hospital, nursing home, home health 

21 care agency, social assistance facility or program, 

22 hospice, federally qualified health center, nurse man23 aged health center, rural health clinic, or any similar 

24 health care facility that employs direct-care reg25 istered nurses or other health care workers. 


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1 (6) HEALTH CARE WORKER.—The term ‘‘health 

2 care worker’’ means an individual who has been as3 signed by a health care employer to engage in pa4 tient handling, including direct-care registered 

5 nurses, independent contractors, or individuals who 

6 perform the duties of health care workers. 

7 (7) LIFT TEAM.—The term ‘‘lift team’’ means 

8 health care workers with specialized training and 

9 knowledge of safe patient handling, mobility, and in10 jury prevention practices and technology. 

Æ 


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