I 

111TH CONGRESS 

1ST SESSION H. R. 2381 

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

standard to reduce injuries to patients, direct-care registered nurses, 

and all other health care workers by establishing a safe patient handling 

and injury prevention standard, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 13, 2009 

Mr. CONYERS (for himself and Ms. WOOLSEY) introduced the following bill; 

which was referred to the Committee on Education and Labor, 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, 

direct-care registered nurses, and all other health care 

workers by establishing a safe patient handling 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 2009’’. 


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

2 (1) In 2007, direct-care registered nurses 

3 ranked seventh among all occupations for the num4 ber of cases of musculoskeletal disorders resulting in 

5 days away from work—8,580 total cases. Nursing 

6 aides, orderlies, and attendants sustained 24,340 

7 musculoskeletal disorders in 2007, the second high8 est of any occupation. The leading cause of these in9 juries in health care are the result of patient lifting, 

10 transferring, and repositioning injuries. 

11 (2) The physical demands of the nursing pro12 fession lead many nurses to leave the profession. 

13 Fifty-two percent of nurses complain of chronic back 

14 pain and 38 percent suffer from pain severe enough 

15 to require leave from work. Many nurses and other 

16 health care workers suffering back injury do not re17 turn to work. 

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

19 while being lifted, transferred, or repositioned manu20 ally. Mechanical lift programs can substantially re21 duce skin tears suffered by patients and the fre22 quency of patients being dropped, thus allowing pa23 tients a safer means to progress through their care. 

24 (4) The development of assistive patient han25 dling equipment and devices has essentially rendered 


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1 the act of strict manual patient handling unneces2 sary as a function of nursing care. 

3 (5) A growing number of health care facilities 

4 have incorporated patient handling technology and 

5 have reported positive results. Injuries among nurs6 ing staff have dramatically declined since imple7 menting patient handling equipment and devices. As 

8 a result, the number of lost work days due to injury 

9 and staff turnover has declined. Studies have also 

10 shown that assistive patient handling technology suc11 cessfully reduces workers’ compensation costs for 

12 musculoskeletal disorders. 

13 (6) Establishing a safe patient handling and in14 jury prevention standard for direct-care registered 

15 nurses and other health care workers is a critical 

16 component in protecting nurses and other health 

17 care workers, addressing the nursing shortage, and 

18 increasing patient safety. 

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

20 this Act is as follows: 

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

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

Sec. 3. Protection of direct-care registered nurses and health care workers. 

Sec. 4. Application of safe patient handling and injury prevention standard to 

health care facilities not covered by OSHA. 

Sec. 5. Financial assistance to needy health care facilities in the purchase of 

safe patient handling and injury prevention equipment. 

Sec. 6. Definitions. 


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1 SEC. 2. SAFE PATIENT HANDLING AND INJURY PREVEN2 TION STANDARD. 

3 (a) RULEMAKING.—Not later than 1 year after the 

4 date of the enactment of this Act, the Secretary of Labor, 

5 shall, pursuant to section 6 of the Occupational Safety and 

6 Health Act of 1970 (29 U.S.C. 655), propose a standard 

7 on safe patient handling and injury prevention (in this sec8 tion such standard referred to as the ‘‘safe patient han9 dling and injury prevention standard’’) under such section 

10 to prevent musculoskeletal disorders for direct-care reg11 istered nurses and all other health care workers handling 

12 patients in health care facilities. A final safe patient han13 dling and injury prevention standard shall be promulgated 

14 not later than 2 years after the date of the enactment of 

15 this Act. 

16 (b) REQUIREMENTS.—The safe patient handling and 

17 injury prevention standard shall require the use of engi18 neering controls to perform lifting, transferring, and repo19 sitioning of patients and the elimination of manual lifting 

20 of patients by direct-care registered nurses and all other 

21 health care workers, through the use of mechanical devices 

22 to the greatest degree feasible except where the use of safe 

23 patient handling practices can be demonstrated to com24 promise patient care. The standard shall apply to all 

25 health care employers and shall require at least the fol26 lowing: 


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1 (1) Each health care employer to develop and 

2 implement a safe patient handling and injury pre3 vention plan within 6 months of the date of promul4 gation of the final standard, which plan shall include 

5 hazard identification, risk assessments, and control 

6 measures in relation to patient care duties and pa7 tient handling. 

8 (2) Each health care employer to purchase, use, 

9 maintain, and have accessible an adequate number 

10 of safe lift mechanical devices not later than 2 years 

11 after the date of issuance of a final regulation estab12 lishing such standard. 

13 (3) Each health care employer to obtain input 

14 from direct-care registered nurses, health care work15 ers, and employee representatives of direct-care reg16 istered nurses and health care workers in developing 

17 and implementing the safe patient handling and in18 jury prevention plan, including the purchase of 

19 equipment. 

20 (4) Each health care employer to establish and 

21 maintain a data system that tracks and analyzes 

22 trends in injuries relating to the application of the 

23 safe patient handling and injury prevention standard 

24 and to make such data and analyses available to em25 ployees and employee representatives. 


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1 (5) Each health care employer to establish a 

2 system to document in each instance when safe pa3 tient handling equipment was not utilized due to le4 gitimate concerns about patient care and to generate 

5 a written report in each such instance. The report 

6 shall list the following: 

7 (A) The work task being performed. 

8 (B) The reason why safe patient handling 

9 equipment was not used. 

10 (C) The nature of the risk posed to the 

11 worker from manual lifting. 

12 (D) The steps taken by management to re13 duce the likelihood of manual lifting and trans14 ferring when performing similar work tasks in 

15 the future. 

16 Such reports shall be made available to OSHA com17 pliance officers, workers, and their representatives 

18 upon request within one business day. 

19 (6) Each health care employer to train nurses 

20 and other health care workers on safe patient han21 dling and injury prevention policies, equipment, and 

22 devices at least on an annual basis. Such training 

23 shall include providing information on hazard identi24 fication, assessment, and control of musculoskeletal 

25 hazards in patient care areas and shall be conducted 


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1 by an individual with knowledge in the subject mat2 ter, and delivered, at least in part, in an interactive 

3 classroom-based and hands-on format. 

4 (7) Each health care employer to post a uni5 form notice in a form specified by the Secretary 

6 that— 

7 (A) explains the safe patient handling and 

8 injury prevention standard; 

9 (B) includes information regarding safe 

10 patient handling and injury prevention policies 

11 and training; and 

12 (C) explains procedures to report patient 

13 handling-related injuries. 

14 (8) Each health care employer to conduct an 

15 annual written evaluation of the implementation of 

16 the safe patient handling and injury prevention plan, 

17 including handling procedures, selection of equip18 ment and engineering controls, assessment of inju19 ries, and new safe patient handling and injury pre20 vention technology and devices that have been devel21 oped. The evaluation shall be conducted with the in22 volvement of nurses, other health care workers, and 

23 their representatives and shall be documented in 

24 writing. Health care employers shall take corrective 

25 action as recommended in the written evaluation. 


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1 (c) INSPECTIONS.—The Secretary of Labor shall con2 duct unscheduled inspections under section 8 of the Occu3 pational Safety and Health Act of 1970 (29 U.S.C. 657) 

4 to ensure implementation of and compliance with the safe 

5 patient handling and injury prevention standard. 

6 SEC. 3. PROTECTION OF DIRECT-CARE REGISTERED 

7 NURSES AND HEALTH CARE WORKERS. 

8 (a) REFUSAL OF ASSIGNMENT.—The Secretary shall 

9 ensure that a direct-care registered nurse or other health 

10 care worker may refuse to accept an assignment from a 

11 health care employer if— 

12 (1) the assignment would subject the worker to 

13 conditions that would violate the safe patient han14 dling and injury prevention standard; or 

15 (2) the nurse or worker has not received train16 ing described in section 2(a)(5) that meets such 

17 standard. 

18 (b) RETALIATION FOR REFUSAL OF LIFTING ASSIGN19 MENT BARRED.— 

20 (1) NO DISCHARGE, DISCRIMINATION, OR RE21 TALIATION.—No health care employer shall dis22 charge, discriminate, or retaliate in any manner with 

23 respect to any aspect of employment, including dis24 charge, promotion, compensation, or terms, condi25 tions, or privileges of employment, against a directVerDate Nov 24 2008 00:35 May 15, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2381.IH H2381

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1 care registered nurse or other health care worker 

2 based on the nurse’s or worker’s refusal of a lifting 

3 assignment under subsection (a). 

4 (2) NO FILING OF COMPLAINT.—No health care 

5 employer shall file a complaint or a report against 

6 a direct-care registered nurse or other health care 

7 worker with the appropriate State professional dis8 ciplinary agency because of the nurse’s or worker’s 

9 refusal of a lifting assignment under subsection (a). 

10 (c) WHISTLEBLOWER PROTECTION.— 

11 (1) RETALIATION BARRED.—A health care em12 ployer shall not discriminate or retaliate in any man13 ner with respect to any aspect of employment, in14 cluding hiring, discharge, promotion, compensation, 

15 or terms, conditions, or privileges of employment 

16 against any nurse or health care worker who in good 

17 faith, individually or in conjunction with another 

18 person or persons— 

19 (A) reports a violation or a suspected viola20 tion of this Act or the safe patient handling and 

21 injury prevention standard to the Secretary of 

22 Labor, a public regulatory agency, a private ac23 creditation body, or the management personnel 

24 of the health care employer; 


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1 (B) initiates, cooperates, or otherwise par2 ticipates in an investigation or proceeding 

3 brought by the Secretary, a public regulatory 

4 agency, or a private accreditation body con5 cerning matters covered by this Act; or 

6 (C) informs or discusses with other individ7 uals or with representatives of health care em8 ployees a violation or suspected violation of this 

9 Act. 

10 (2) GOOD FAITH DEFINED.—For purposes of 

11 this subsection, an individual shall be deemed to be 

12 acting in good faith if the individual reasonably be13 lieves— 

14 (A) the information reported or disclosed is 

15 true; and 

16 (B) a violation of this Act or the safe pa17 tient handling and injury prevention standard 

18 has occurred or may occur. 

19 (d) COMPLAINT TO SECRETARY.— 

20 (1) FILING.—A direct-care registered nurse, 

21 health care worker, or other individual may file a 

22 complaint with the Secretary of Labor against a 

23 health care employer that violates this section within 

24 180 days of the date of the violation. 


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1 (2) RESPONSE TO COMPLAINT.—For any com2 plaint so filed, the Secretary shall— 

3 (A) receive and investigate the complaint; 

4 (B) determine whether a violation of this 

5 Act as alleged in the complaint has occurred; 

6 and 

7 (C) if such a violation has occurred, issue 

8 an order that sets forth the violation and the 

9 required remedy or remedies. 

10 (3) REMEDIES.—The Secretary shall have the 

11 authority to order all appropriate remedies for such 

12 violations. 

13 (e) CAUSE OF ACTION.—Any direct-care registered 

14 nurse or other health care worker who has been dis15 charged, discriminated, or retaliated against in violation 

16 of this section may bring a cause of action in a United 

17 States district court. A direct-care registered nurse or 

18 other health care worker who prevails on the cause of ac19 tion shall be entitled to the following: 

20 (1) Reinstatement, reimbursement of lost 

21 wages, compensation, and benefits. 

22 (2) Attorneys’ fees. 

23 (3) Court costs. 

24 (4) Other damages. 


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1 (f) NOTICE.—A health care employer shall include in 

2 the notice required under section 2(b)(7) an explanation 

3 of the rights of direct-care registered nurses and health 

4 care workers under this section and a statement that a 

5 direct-care registered nurse or health care worker may file 

6 a complaint with the Secretary against a health care em7 ployer that violates the safe patient handling and injury 

8 prevention standard, including instructions for how to file 

9 such a complaint. 

10 (g) ADDITION TO CURRENT PROTECTIONS.—The 

11 worker protections provided for under this section are in 

12 addition to protections provided in section 11(c) of the Oc13 cupational Safety and Health Act of 1970 (29 U.S.C. 

14 660(c)). 

15 SEC. 4. APPLICATION OF SAFE PATIENT HANDLING AND IN16 JURY PREVENTION STANDARD TO HEALTH 

17 CARE FACILITIES NOT COVERED BY OSHA. 

18 (a) IN GENERAL.—Section 1866 of the Social Secu19 rity Act (42 U.S.C. 1395cc) is amended— 

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

21 safe patient handling and injury prevention standard 

22 (as initially promulgated under section 2 of the 

23 Nurse and Health Care Worker Protection Act of 

24 2009)’’ before the period at the end; and 

25 (2) in subsection (b)(4)— 


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

2 the safe patient handling and injury prevention 

3 standard’’ after ‘‘Bloodborne Pathogens stand4 ard’’; and 

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

6 safe patient handling and injury prevention 

7 standard’’ after ‘‘Bloodborne Pathogens stand8 ard’’. 

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

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

11 after date of issuance of the final safe patient handling 

12 and injury prevention standard required under section 2. 

13 SEC. 5. FINANCIAL ASSISTANCE TO NEEDY HEALTH CARE 

14 FACILITIES IN THE PURCHASE OF SAFE PA15 TIENT HANDLING AND INJURY PREVENTION 

16 EQUIPMENT. 

17 (a) IN GENERAL.—The Secretary of Health and 

18 Human Services shall establish a grant program that pro19 vides financial assistance to cover some or all of the costs 

20 of purchasing safe patient handling and injury prevention 

21 equipment for health care facilities, such as hospitals, 

22 nursing facilities, home health care, and outpatient facili23 ties, that— 


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1 (1) require the use of such equipment in order 

2 to comply with the safe patient handling and injury 

3 prevention standard; but 

4 (2) demonstrate the financial need for assist5 ance for purchasing the equipment required under 

6 such standard. 

7 (b) APPLICATION.—No financial assistance shall be 

8 provided under this section except pursuant to an applica9 tion made to the Secretary of Health and Human Services 

10 in such form and manner as the Secretary shall specify. 

11 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated for financial assistance 

13 under this section $200,000,000, of which $50,000,000 

14 will be available specifically for home health agencies or 

15 entities. Funds appropriated under this subsection shall 

16 remain available until expended. 

17 SEC. 6. DEFINITIONS. 

18 For purposes of this Act: 

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

20 term ‘‘direct-care registered nurse’’ means an indi21 vidual who has been granted a license by at least 

22 one State to practice as a registered nurse and who 

23 provides bedside care or outpatient services for one 

24 or more patients or residents. 


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

2 care worker’’ means an individual who has been as3 signed to lift, reposition, or move patients or resi4 dents in a health care facility. 

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

6 includes the provision of services under a contract or 

7 other arrangement. 

8 (4) HEALTH CARE EMPLOYER.—The term 

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

10 care facility, hospital, nursing home, home health 

11 care agency, hospice, federally qualified health cen12 ter, nurse managed health center, rural health clinic, 

13 or any similar health care facility that employs di14 rect-care registered nurses or other health care 

15 workers. 

Æ 


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