I 
109TH CONGRESS 
2D SESSION 
H. R. 6182 
To amend the Occupational Safety and Health Act of 1970 to reduce injuries 
to patients, direct-care registered nurses, and other health care providers 
by establishing a safe patient handling standard. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 26, 2006 
Mr. CONYERS introduced the following bill; which was referred to the Com-
mittee on Education and the Workforce, and in addition to the Com-
mittee on Energy and Commerce, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Occupational Safety and Health Act of 1970 
to reduce injuries to patients, direct-care registered 
nurses, and other health care providers by establishing 
a safe patient handling standard. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Nurse And Patient Safety & Protection Act of 2006’’. 
(b) FINDINGS.—Congress finds the following: 
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(1) Direct-care registered nurses rank 10th 
among all occupations for musculoskeletal disorders, 
sustaining injuries at a higher rate than laborers, 
movers, and truck drivers. In 2004, nurses sustained 
8,800 musculoskeletal disorders, most of which (over 
7,000) were back injuries. The leading cause of 
these injuries in health care are the result of patient 
lifting, transferring, and repositioning injuries. 
(2) The physical demands of the nursing pro-
fession lead many nurses to leave the profession. 
Fifty two percent of nurses complain of chronic back 
pain and 38 percent suffer from pain severe enough 
to require leave from work. Many nurses and other 
health care providers suffering back injury do not 
return to work. 
(3) Patients are not at optimum levels of safety 
while being lifted, transferred, or repositioned manu-
ally. Mechanical lift programs can substantially re-
duce skin tears suffered by patients, allowing pa-
tients a safer means to progress through their care. 
(4) The development of assistive patient han-
dling equipment and devices has essentially rendered 
the act of strict manual patient handling unneces-
sary as a function of nursing care. 
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(5) Application of assistive patient handling 
technology fulfills an ergonomic approach within the 
nursing practice by designing and fitting the job or 
workplace to match the capabilities and limitations 
of the human body. 
(6) A growing number of health care facilities 
have incorporated patient handling technology and 
have reported positive results. Injuries among nurs-
ing staff have dramatically declined since imple-
menting patient handling equipment and devices. As 
a result, the number of lost work days due to injury 
and staff turnover has declined. Cost-benefit anal-
yses have also shown that assistive patient handling 
technology successfully reduces workers’ compensa-
tion costs for musculoskeletal disorders. 
(7) Establishing a safe patient handling stand-
ard for direct-care registered nurses and other 
health care providers is a critical component in in-
creasing patient safety, protecting nurses, and ad-
dressing the nursing shortage. 
SEC. 2. FEDERAL SAFE PATIENT HANDLING STANDARD. 
Not later than 1 year after the date of the enactment 
of this title, the Secretary of Labor, acting through the 
Director of Occupational Safety and Health Administra-
tion, shall establish a Federal Safe Patient Handling 
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Standard to prevent musculoskeletal disorders for direct- 
care registered nurses and other health care providers 
working in health care facilities. This standard shall re-
quire the elimination of manual lifting of patients by di-
rect-care registered nurses and other health care pro-
viders, through the use of mechanical devices, except dur-
ing a declared state of emergency. The standard shall in-
clude a musculoskeletal injury prevention plan, which will 
include hazard identification and risk assessments in rela-
tion to patient care duties and patient handling. The 
standard shall require: 
(1) all health care facilities comply with the 
standard; 
(2) health care facilities to purchase, use, and 
maintain safe lift mechanical devices; 
(3) input from direct-care registered nurses and 
organizations representing direct-care registered 
nurses in implementing the standard; 
(4) a program to identify problems and solu-
tions regarding safe patient handling; 
(5) a system to report, track, and analyze 
trends in injuries, as well as make injury data avail-
able to the public; 
(6) training for staff on safe patient handling 
policies, equipment, and devices at least on an an-
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nual basis. Training will also include hazard identi-
fication, assessment and control of musculoskeletal 
hazards in patient care areas, this would include 
interactive classroom based and hands on training 
by a knowledgeable person or staff; and 
(7) annual evaluations of safe patient handling 
efforts, as well as new technology, handling proce-
dures, and engineering controls. Documentation of 
this process shall include equipment selection and 
evaluation. 
SEC. 3. REQUIREMENT FOR HEALTH CARE FACILITIES. 
(a) SAFE PATIENT HANDLING PLAN.—In accordance 
with the standard required under section 2, and not later 
than 6 months after such standard is published, health 
care facilities shall develop and implement a safe patient 
handling plan that— 
(1) provides adequate, appropriate, and quality 
delivery of health care services that protects patient 
safety and prevents musculoskeletal disorders for di-
rect-care registered nurses and other health care 
providers; 
(2) is consistent with the requirements of the 
Federal Safe Patient Handling Standard (as estab-
lished in section 2); 
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(3) provides for input by direct-care registered 
nurses and organizations representing direct-care 
registered nurses in implementing the plan; and 
(4) ensures that safe lifting mechanical devices 
shall only be used by direct care registered nurses 
and other health care providers. 
(b) POSTING, RECORDS, AND AUDITING.— 
(1) POSTING REQUIREMENTS.—Not later than 
6 months after the standard required under section 
2 is published, a health care facility shall post, in 
each unit of the facility, a uniform notice in a form 
specified by the Secretary in regulation that— 
(A) explains the Federal Safe Patient 
Handling Standard issued under section 2; 
(B) includes information regarding safe 
patient handling polices and training; and 
(C) explains procedure to report patient 
handling-related injuries. 
(2) AUDITS.—The Secretary shall require the 
Occupational Safety and Health Administration to 
conduct unscheduled audits to ensure— 
(A) implementation of the safe patient 
handling plan in accordance with this title; and 
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(B) compliance with reporting and review-
ing findings for continual improvements to the 
safe patient handling plan. 
SEC. 
4. 
PROTECTION 
OF 
DIRECT-CARE 
REGISTERED 
NURSES AND OTHER INDIVIDUALS. 
(a) REFUSAL OF ASSIGNMENT.—A direct-care reg-
istered nurse or other health care provider may refuse to 
accept an assignment in a health care facility if— 
(1) the assignment would violate the standard 
establish under section 2; or 
(2) the direct-care registered nurse or other 
health care provider is not prepared by education, 
training, or experience to fulfill the assignment with-
out compromising the safety of any patient or jeop-
ardizing the license of the nurse. 
(b) RETALIATION FOR REFUSAL OF ASSIGNMENT 
BARRED.— 
(1) NO DISCHARGE, DISCRIMINATION, OR RE-
TALIATION.—No health care facility shall discharge, 
discriminate, or retaliate in any manner with respect 
to any aspect of employment, including discharge, 
promotion, compensation, or terms, conditions, or 
privileges of employment, against a direct-care reg-
istered nurse or other health care provider based on 
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his or her refusal of a work assignment under sub-
section (a). 
(2) NO FILING OF COMPLAINT.—No health care 
facility shall file a complaint or a report against a 
direct-care registered nurse or other health care pro-
vider with the appropriate State professional discipli-
nary agency because of his or her refusal of a work 
assignment under subsection (a). 
(c) COMPLAINT TO SECRETARY.—A direct-care reg-
istered nurse, health care provider, or other individual 
may file a complaint with the Secretary against a health 
care facility that violates this Act or a standard estab-
lished under this Act. For any complaint filed, the Sec-
retary shall— 
(1) receive and investigate the complaint; 
(2) determine whether a violation of this Act as 
alleged in the complaint has occurred; and 
(3) if such a violation has occurred, issue an 
order that the complaining direct-care registered 
nurse, health care provider, or other individual shall 
not suffer any retaliation under subsection (b) or 
under subsection (d). 
(d) WHISTLEBLOWER PROTECTION.— 
(1) RETALIATION BARRED.—A health care fa-
cility shall not discriminate or retaliate in any man-
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ner with respect to any aspect of employment, in-
cluding hiring, discharge, promotion, compensation, 
or terms, conditions, or privileges of employment 
against any individual who in good faith, individually 
or in conjunction with another person or persons— 
(A) reports a violation or a suspected viola-
tion of this Act or the standard established 
under this Act to the Secretary, a public regu-
latory agency, a private accreditation body, or 
the management personnel of the health care 
facility; 
(B) initiates, cooperates, or otherwise par-
ticipates in an investigation or proceeding 
brought by the Secretary, a public regulatory 
agency, or a private accreditation body con-
cerning matters covered by this Act; or 
(C) informs or discusses with other individ-
uals or with representatives of health care facil-
ity employees a violation or suspected violation 
of this Act. 
(2) GOOD FAITH DEFINED.—For purposes of 
this subsection, an individual shall be deemed to be 
acting in good faith if the individual reasonably be-
lieves— 
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(A) the information reported or disclosed is 
true; and 
(B) a violation of this Act or the standard 
established under this Act has occurred or may 
occur. 
(e) CAUSE OF ACTION.—Any direct-care registered 
nurse or other health care provider who has been dis-
charged, discriminated, or retaliated against in violation 
of subsection (b)(1) or (d), or against whom a complaint 
has been filed in violation of subsection (b)(2), may bring 
a cause of action in a United States district court. A di-
rect-care registered nurse or other health care provider 
who prevails on the cause of action shall be entitled to 
one or more of the following: 
(1) Reinstatement. 
(2) Reimbursement of lost wages, compensa-
tion, and benefits. 
(3) Attorneys’ fees. 
(4) Court costs. 
(5) Other damages. 
(f) NOTICE.—A health care facility shall include in 
the notice required under section 3(b) an explanation of 
the rights of direct-care registered nurses, health care pro-
viders, and other individuals under this section and a 
statement that a direct-care registered nurse, health care 
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provider, or other individual may file a complaint with the 
Secretary against a health care facility that violates the 
standard issued under section 2, including instructions for 
how to file such a complaint. 
SEC. 5. DEFINITIONS. 
For purposes of this Act: 
(1) DIRECT-CARE
REGISTERED
NURSE.—The 
term ‘‘direct care registered nurse’’ means an indi-
vidual who has been granted a license by at least 1 
State to practice as a registered nurse and who pro-
vides bedside care or outpatient services for 1 or 
more patients. 
(2) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means any person required 
by State or Federal laws or regulations to be li-
censed, registered, or certified to provide health care 
services, and being either so licensed, registered, or 
certified, or exempted from such requirement by 
other statute or regulation. 
(3) EMPLOYMENT.—The term ‘‘employment’’ 
includes the provision of services under a contract or 
other arrangement. 
(4) 
HEALTH
CARE
FACILITY.—The 
term 
‘‘health care facility’’ means an outpatient health 
care facility, hospital, nursing home, home health 
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