,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #bdhj  ,,in ,,the ,,house ,,of  
,,representatives  ,june #be1 #bjac ,mr4
 ,conyers 7for himself and ,mr4 ,george 
,miller of ,california7 introduced the  
following bill2 which was referred to   
the ,committee on ,education and the    
,workforce1 and in addition to the      
,committees on ,energy and ,commerce and
 ,ways and ,means1 for a period to be   
subsequently determined by the ,speaker1
 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 patients1 nurses1 and all other      
health care workers by establishing a   
safe patient handling1 mobility1 and    
injury prevention standard1 and for     
other purposes4  #a4 ,short title2      
findings2 table of contents  7a7 ,short 
,title ,this ,act may be cited as the   
,nurse and ,health ,care ,worker        

,protection ,act of #bjac4  7b7         
,findings ,congress finds the following3
  7#a7 ,in #bjaa1 registered nurses     
ranked fifth among all occupations for  
the number of cases of musculoskeletal  
disorders resulting in days away from   
work1 with #aa1hhj total cases4 ,in     
#bjaa1 nursing assistants reported      
#be1jaj cases--the highest of all       
occupations4 ,the leading cause of these
 health care employees' injuries is     
patient lifting1 transferring1 and      
repositioning injuries1 which constitute
 a significant risk to the health and   
welfare of those employees4  7#b7 ,the  
physical demands of the nursing         
profession lead many nurses to leave the
 profession4 ,fifty-two percent of      
nurses complain of chronic back pain and
 #ch percent suffer from pain severe    
enough to require leave from work4 ,many
 nurses and other health care workers   
suffering back injury do not return to  
work4 ,these consequences constitute a  
material impairment of health for these 

employees4  7#c7 ,patients are not at   
optimum levels of safety while being    
lifted1 transferred1 or repositioned    
manually4 ,mechanical and other         
appropriate lift programs can           
substantially reduce skin tears and     
pressure ulcers suffered by patients and
 the frequency of patients being        
dropped1 thus allowing patients a safer 
means to progress through their care4   
7#d7 ,the development of assistive      
patient handling technology1 equipment1 
and devices has essentially rendered the
 act of strict manual patient handling  
outdated and typically unnecessary as a 
function of nursing care4  7#e7 ,a      
growing number of health care facilities
 that have incorporated patient handling
 technology and practices have reported 
positive results4 ,injuries among       
nursing staff and health care workers   
have dramatically declined at health    
care facilities implementing safe       
patient handling technology1 equipment1 
devices1 and practices4 ,as a result1   

the number of lost work days due to     
injury and staff turnover has declined4 
,studies have also shown that assistive 
patient handling technology successfully
 reduces workers' compensation costs for
 musculoskeletal disorders4  7#f7 ,a    
number of ,states have implemented safe 
patient handling1 mobility and injury   
prevention standards4 ,the success of   
these programs at the facility and      
,state level demonstrates the           
feasibility of such standards4  7#g7    
,establishing a safe patient handling1  
mobility1 and injury prevention standard
 for direct-care registered nurses and  
other health care workers is a critical 
component reasonably necessary for      
protecting the health and safety of     
nurses and other health care workers1   
addressing the nursing shortage1 and    
increasing patient safety4  7c7 ,table  
of contents ,the table of contents of   
this ,act is as follows3  ,sec4 #a4     
,short title2 findings2 table of        
contents4 ,sec4 #b4 ,safe patient       

handling1 mobility1 and injury          
prevention standard4 ,sec4 #c4          
,application of safe patient handling1  
mobility1 and injury prevention standard
 to facilities receiving ,medicare and  
,medicaid funds4 ,sec4 #d4              
,nonpreemption4 ,sec4 #e4 ,definitions4 
#b4 ,safe patient handling1 mobility1   
and injury prevention standard  7a7     
,rulemaking ,notwithstanding any other  
provision of law1 not later than #a year
 after the date of enactment of this    
,act1 the ,secretary of ,labor shall1   
pursuant to section #f of the           
,occupational ,safety and ,health ,act  
of #aigj 7#bi ,u4,s4,c4 #fee71          
promulgate an interim final standard on 
safe patient handling1 mobility1 and    
injury prevention 7in this section such 
standard is referred to as the safe     
patient handling1 mobility1 and injury  
prevention standard7 to prevent         
musculoskeletal disorders for           
direct-care registered nurses and all   
other health care workers handling      

patients4 ,a final safe patient         
handling1 mobility1 and injury          
prevention standard shall be promulgated
 not later than #b years after the date 
of enactment of this ,act4  7b7         
,requirements ,the safe patient         
handling1 mobility1 and injury          
prevention standard shall require the   
use of engineering and safety controls  
to perform handling of patients and the 
elimination of injuries from manual     
handling of patients by direct-care     
registered nurses and all other health  
care workers1 through the development of
 a comprehensive program1 to include the
 use of mechanical technology and       
devices to the greatest degree feasible4
 ,where the use of mechanical technology
 and devices is not feasible1 the       
standards shall require the use of      
alternative controls and measures1      
including trained1 designated lift      
teams1 to minimize the risk of injury to
 nurses and health care workers         
resulting from the manual handling of   

patients4 ,the standard shall apply to  
all health care employers1 shall        
generally align with interprofessional  
national safe patient handling1         
mobility1 and injury prevention         
standards1 and shall include the        
following3  7#a7 ,program development ,a
 requirement that each health care      
employer shall develop and implement a  
safe patient handling1 mobility1 and    
injury prevention program within #f     
months of the date of promulgation of   
the final standard1 which program shall 
include hazard identification1 risk     
assessments1 and control measures in    
relation to patient care duties and     
patient handling4  7#b7 ,technology and 
equipment purchase and management ,a    
requirement that1 within #b years of the
 date of promulgation of the final      
standard1 each health care employer     
shall purchase1 use1 maintain1 and make 
accessible to health care workers1 such 
safe patient handling equipment1        
technology1 and accessories as the      

,secretary determines appropriate4  7#c7
 ,health care worker participation ,a   
requirement that each health care       
employer shall obtain input from health 
care workers1 to include direct care    
registered nurses1 health care workers1 
their representatives1 and their        
collective bargaining agents1 in        
developing and implementing the safe    
patient handling1 mobility1 and injury  
prevention program1 including the       
purchase of technology and equipment and
 necessary accessories4  7#d7 ,data     
tracking and review ,a requirement that 
each health care employer shall         
establish a review program to analyze   
data relevant to the implementation of  
the employers' safe patient handling1   
mobility1 and injury prevention program1
 and shall account for circumstances    
where safe patient handling technology  
and equipment1 or trained1 designated   
lift teams1 were not utilized in        
accordance with the health care         
employers safe patient handling1        

mobility1 and injury prevention         
standard4 ,each health care employer    
shall upon request1 make available their
 findings and data used in such review1 
to health care workers1 their           
representatives1 their collective       
bargaining agents1 and the ,secretary or
 other ,federal agency4  7#e7           
,incorporation of ,technology into      
,facilities ,a requirement that each    
health care employer shall consider the 
feasibility of incorporating safe       
patient handling technology as part of  
process of new facility design and      
construction1 or facility remodeling4   
7#f7 ,education and training ,a         
requirement that each health care       
employer shall train health care workers
 on safe patient handling1 mobility1 and
 injury prevention policies1 technology1
 equipment1 and devices1 initially1 and 
on a continuing annual basis1 and as    
necessary4 ,such training shall prepare 
health care workers1 including          
designated lift teams1 to identify1     

assess1 and control musculoskeletal     
hazards of a general nature1 and those  
specific to particular patient care     
areas1 and shall be conducted by an     
individual with knowledge in the subject
 matter1 and delivered1 at least in     
part1 in an interactive simulated       
point-of-care training and hands-on     
format that reflects the specific       
demands of a health care workers'       
duties4  7#g7 ,notice of safe patient   
handling and rights under this ,act ,a  
requirement that each health care       
employer shall post a uniform notice in 
a form specified by the ,secretary      
that--  7,a7 explains the safe patient  
handling1 mobility1 and injury          
prevention standard2  7,b7 includes     
information regarding safe patient      
handling1 mobility1 and injury          
prevention policies and training2  7,c7 
explains procedures to report patient   
handling-related injuries2 and  7,d7    
explains health care workers' rights    
under this ,act4  7#h7 ,annual          

evaluation ,a requirement that each     
health care employer shall conduct an   
annual written evaluation of the        
implementation of the safe patient      
handling1 mobility1 and injury          
prevention program1 including handling  
procedures1 selection of technology1    
equipment1 and engineering controls1    
assessment of injuries1 and new safe    
patient handling1 mobility1 and injury  
prevention technology and devices that  
have been developed4 ,the evaluation    
shall be conducted with the involvement 
of nurses1 other health care workers1   
their representatives1 and their        
collective bargaining agents1 and their 
input shall be documented in the        
evaluation4 ,health care employers shall
 take corrective action as recommended  
in the written evaluation4  7#i7 ,right 
to ,refuse ,unsafe ,assignment ,a       
requirement that each health care       
employer shall provide procedures under 
which a health care worker or employee  
may refuse to perform the employee's    

duties if the employee has a reasonable 
apprehension that performing such duties
 would violate the safe patient         
handling1 mobility1 and injury          
prevention standard1 and would result in
 injury or impairment of health to the  
health care worker1 other health care   
workers1 or patients4 ,where            
practicable1 the health care worker must
 have communicated the health or safety 
concern to the health care employer and 
have not been able to obtain a          
correction of the violation4  7c7       
,inspections ,the ,secretary of ,labor  
shall conduct unscheduled inspections   
under section #h of the ,occupational   
,safety and ,health ,act of #aigj 7#bi  
,u4,s4,c4 #feg7 to ensure implementation
 of and compliance with the safe patient
 handling1 mobility1 and injury         
prevention standard4  #c4 ,application  
of safe patient handling1 mobility1 and 
injury prevention standard to facilities
 receiving ,medicare and ,medicaid funds
  7a7 ,in general ,section #ahff of the 

,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7 is amended--  7#a7 in         
subsection 7a77#a77,v71 by inserting and
 safe patient handling1 mobility1 and   
injury prevention standard 7as initially
 promulgated under section #b of the    
,nurse and ,health ,care ,worker        
,protection ,act of #bjji7 before the   
period at the end2 and  7#b7 in         
subsection 7b77#d7--  7,a7 in           
subparagraph 7,a71 inserting and the    
safe patient handling1 mobility1 and    
injury prevention standard after        
,bloodborne ,pathogens standard2 and    
7,b7 in subparagraph 7,b71 inserting or 
the safe patient handling1 mobility1 and
 injury prevention standard after       
,bloodborne ,pathogens standard4  7b7   
,effective date ,the amendments made by 
subsection 7a7 shall apply to health    
care facilities #a year after date of   
issuance of the final safe patient      
handling1 mobility1 and injury          
prevention standard required under      
section #b4  #d4 ,nonpreemption  7a7    

,effect on other laws ,nothing in this  
,act shall be construed to--  7#a7      
preempt any law1 rule1 or regulation of 
a ,state or political subdivision of a  
,state1 unless such law1 rule1 or       
regulation is in conflict with this ,act
 or a regulation or order issued under  
this ,act2 or  7#b7 impair or diminish  
in any way the authority of any ,state  
to enact and enforce any law which      
provides equivalent or greater          
protections for employees engaging in   
conduct protected under this ,act4  7b7 
,rights ,retained by ,health ,care      
,workers ,nothing in this ,act shall be 
construed to diminish the rights1       
privileges1 or remedies of any health   
care worker or employee under any       
,federal or ,state law1 or under any    
collective bargaining agreement4  #e4   
,definitions ,for purposes of this ,act3
  7#a7 ,direct-care registered nurse    
,the term direct-care registered nurse  
means an individual who has been granted
 a license by at least one ,state to    

practice as a registered nurse and who  
provides bedside care or outpatient     
services for one or more patients or    
residents4  7#b7 ,employee ,the term    
employee means any individual employed  
by a health care employer1 to include   
health care workers1 as well as         
employees who do not qualify as health  
care workers1 including independent     
contractors4  7#c7 ,employment ,the term
 employment includes the provision of   
services under a contract or other      
arrangement4  7#d7 ,handling ,the term  
handling includes actions such as       
lifting1 transferring1 repositioning1   
mobilizing1 moving1 or any other action 
involving the physical movement1        
manipulation1 or support of a patient by
 a health care worker1 or any direct    
patient care action which presents a    
risk of musculoskeletal injury4  7#e7   
,health care employer ,the term health  
care employer means an outpatient health
 care facility1 hospital1 nursing home1 
home health care agency1 social         

assistance facility or program1 hospice1
 federally qualified health center1     
nurse managed health center1 rural      
health clinic1 or any similar health    
care facility that employs direct-care  
registered nurses or other health care  
workers4  7#f7 ,health care worker ,the 
term health care worker means an        
individual who has been assigned by a   
health care employer to engage in       
patient handling1 including direct-care 
registered nurses1 independent          
contractors1 or individuals who perform 
the duties of health care workers4  7#g7
 ,lift team ,the term lift team means   
health care workers with specialized    
training and knowledge of safe patient  
handling1 mobility1 and injury          
prevention practices and technology4