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 jurisdic-
tion 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 in-
jury prevention standard, and for other purposes. 
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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Nurse and Health Care Worker Protection Act of 2009’’. 
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(b) FINDINGS.—Congress finds the following: 
(1) In 2007, direct-care registered nurses 
ranked seventh among all occupations for the num-
ber of cases of musculoskeletal disorders resulting in 
days away from work—8,580 total cases. Nursing 
aides, orderlies, and attendants sustained 24,340 
musculoskeletal disorders in 2007, the second high-
est of any occupation. The leading cause of these in-
juries 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 workers suffering back injury do not re-
turn 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 and the fre-
quency of patients being dropped, thus 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 
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the act of strict manual patient handling unneces-
sary as a function of nursing care. 
(5) 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. Studies have also 
shown that assistive patient handling technology suc-
cessfully reduces workers’ compensation costs for 
musculoskeletal disorders. 
(6) Establishing a safe patient handling and in-
jury prevention standard for direct-care registered 
nurses and other health care workers is a critical 
component in protecting nurses and other health 
care workers, addressing the nursing shortage, and 
increasing patient safety. 
(c) TABLE OF CONTENTS.—The table of contents of 
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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SEC. 2. SAFE PATIENT HANDLING AND INJURY PREVEN-
TION STANDARD. 
(a) RULEMAKING.—Not later than 1 year after the 
date of the enactment of this Act, the Secretary of Labor, 
shall, pursuant to section 6 of the Occupational Safety and 
Health Act of 1970 (29 U.S.C. 655), propose a standard 
on safe patient handling and injury prevention (in this sec-
tion such standard referred to as the ‘‘safe patient han-
dling and injury prevention standard’’) under such section 
to prevent musculoskeletal disorders for direct-care reg-
istered nurses and all other health care workers handling 
patients in health care facilities. A final safe patient han-
dling and injury prevention standard shall be promulgated 
not later than 2 years after the date of the enactment of 
this Act. 
(b) REQUIREMENTS.—The safe patient handling and 
injury prevention standard shall require the use of engi-
neering controls to perform lifting, transferring, and repo-
sitioning of patients and the elimination of manual lifting 
of patients by direct-care registered nurses and all other 
health care workers, through the use of mechanical devices 
to the greatest degree feasible except where the use of safe 
patient handling practices can be demonstrated to com-
promise patient care. The standard shall apply to all 
health care employers and shall require at least the fol-
lowing: 
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(1) Each health care employer to develop and 
implement a safe patient handling and injury pre-
vention plan within 6 months of the date of promul-
gation of the final standard, which plan shall include 
hazard identification, risk assessments, and control 
measures in relation to patient care duties and pa-
tient handling. 
(2) Each health care employer to purchase, use, 
maintain, and have accessible an adequate number 
of safe lift mechanical devices not later than 2 years 
after the date of issuance of a final regulation estab-
lishing such standard. 
(3) Each health care employer to obtain input 
from direct-care registered nurses, health care work-
ers, and employee representatives of direct-care reg-
istered nurses and health care workers in developing 
and implementing the safe patient handling and in-
jury prevention plan, including the purchase of 
equipment. 
(4) Each health care employer to establish and 
maintain a data system that tracks and analyzes 
trends in injuries relating to the application of the 
safe patient handling and injury prevention standard 
and to make such data and analyses available to em-
ployees and employee representatives. 
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(5) Each health care employer to establish a 
system to document in each instance when safe pa-
tient handling equipment was not utilized due to le-
gitimate concerns about patient care and to generate 
a written report in each such instance. The report 
shall list the following: 
(A) The work task being performed. 
(B) The reason why safe patient handling 
equipment was not used. 
(C) The nature of the risk posed to the 
worker from manual lifting. 
(D) The steps taken by management to re-
duce the likelihood of manual lifting and trans-
ferring when performing similar work tasks in 
the future. 
Such reports shall be made available to OSHA com-
pliance officers, workers, and their representatives 
upon request within one business day. 
(6) Each health care employer to train nurses 
and other health care workers on safe patient han-
dling and injury prevention policies, equipment, and 
devices at least on an annual basis. Such training 
shall include providing information on hazard identi-
fication, assessment, and control of musculoskeletal 
hazards in patient care areas and shall be conducted 
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by an individual with knowledge in the subject mat-
ter, and delivered, at least in part, in an interactive 
classroom-based and hands-on format. 
(7) Each health care employer to post a uni-
form notice in a form specified by the Secretary 
that— 
(A) explains the safe patient handling and 
injury prevention standard; 
(B) includes information regarding safe 
patient handling and injury prevention policies 
and training; and 
(C) explains procedures to report patient 
handling-related injuries. 
(8) Each health care employer to conduct an 
annual written evaluation of the implementation of 
the safe patient handling and injury prevention plan, 
including handling procedures, selection of equip-
ment and engineering controls, assessment of inju-
ries, and new safe patient handling and injury pre-
vention technology and devices that have been devel-
oped. The evaluation shall be conducted with the in-
volvement of nurses, other health care workers, and 
their representatives and shall be documented in 
writing. Health care employers shall take corrective 
action as recommended in the written evaluation. 
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(c) INSPECTIONS.—The Secretary of Labor shall con-
duct unscheduled inspections under section 8 of the Occu-
pational Safety and Health Act of 1970 (29 U.S.C. 657) 
to ensure implementation of and compliance with the safe 
patient handling and injury prevention standard. 
SEC. 
3. 
PROTECTION 
OF 
DIRECT-CARE 
REGISTERED 
NURSES AND HEALTH CARE WORKERS. 
(a) REFUSAL OF ASSIGNMENT.—The Secretary shall 
ensure that a direct-care registered nurse or other health 
care worker may refuse to accept an assignment from a 
health care employer if— 
(1) the assignment would subject the worker to 
conditions that would violate the safe patient han-
dling and injury prevention standard; or 
(2) the nurse or worker has not received train-
ing described in section 2(a)(5) that meets such 
standard. 
(b) RETALIATION FOR REFUSAL OF LIFTING ASSIGN-
MENT BARRED.— 
(1) NO DISCHARGE, DISCRIMINATION, OR RE-
TALIATION.—No health care employer shall dis-
charge, discriminate, or retaliate in any manner with 
respect to any aspect of employment, including dis-
charge, promotion, compensation, or terms, condi-
tions, or privileges of employment, against a direct- 
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care registered nurse or other health care worker 
based on the nurse’s or worker’s refusal of a lifting 
assignment under subsection (a). 
(2) NO FILING OF COMPLAINT.—No health care 
employer shall file a complaint or a report against 
a direct-care registered nurse or other health care 
worker with the appropriate State professional dis-
ciplinary agency because of the nurse’s or worker’s 
refusal of a lifting assignment under subsection (a). 
(c) WHISTLEBLOWER PROTECTION.— 
(1) RETALIATION BARRED.—A health care em-
ployer shall not discriminate or retaliate in any man-
ner with respect to any aspect of employment, in-
cluding hiring, discharge, promotion, compensation, 
or terms, conditions, or privileges of employment 
against any nurse or health care worker 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 safe patient handling and 
injury prevention standard to the Secretary of 
Labor, a public regulatory agency, a private ac-
creditation body, or the management personnel 
of the health care employer; 
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(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 em-
ployees 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— 
(A) the information reported or disclosed is 
true; and 
(B) a violation of this Act or the safe pa-
tient handling and injury prevention standard 
has occurred or may occur. 
(d) COMPLAINT TO SECRETARY.— 
(1) FILING.—A direct-care registered nurse, 
health care worker, or other individual may file a 
complaint with the Secretary of Labor against a 
health care employer that violates this section within 
180 days of the date of the violation. 
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