,,ii  #aadth ,,congress  #ast ,session  
,s4 #bdjh  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,december #af1 
#bjae,mr4 ,franken introduced the       
following bill2 which was read twice and
 referred to the ,committee on ,health1 
,education1 ,labor1 and ,pensions  ,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 #bjae4  7b7         
,findings ,congress finds the following3
  7#a7 ,in #bjad1 registered nurses     
ranked sixth among all occupations for  
the number of cases of musculoskeletal  
disorders resulting in days away from   
work1 with #aa1cfj total cases4 ,nursing

 assistants reported #bj1jbj cases in   
#bjad1 the second highest of any        
profession4 ,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 employees under the    
,occupational ,safety and ,health ,act  
of #aigj 7#bi ,u4,s4,c4 #fea et seq474  
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 employees under the    
,occupational ,safety and ,health ,act  
of #aigj4  7#c7 ,patients are not at    
optimum levels of safety while being    
lifted1 transferred1 or repositioned    

manually4 ,appropriate mechanical lifts 
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 care and
 avoid disabling injuries due to unsafe 
practices4  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 mobility1 and injury  
prevention standards4 ,the success of   
these programs at the facility and      
,state level demonstrates the           
technological and economical 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 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 ,the interim standard shall   

remain in effect until it is replaced by
 a final safe patient handling1         
mobility1 and injury prevention         
standard4  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 to  
reduce the incidence 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 such standard shall require  
the use of alternative controls and     
measures 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 each of 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 not later than
 #f months of the date of promulgation  
of the interim standard1 and such       
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 not     
later than #b years after the date of   
issuance by the ,secretary of ,labor of 
the interim 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 training  
and education and 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 or equipment 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 of
 ,labor or other ,federal agency4 ,each 
health care employer shall maintain the 
data and findings from their review for 
not less than #e years4  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 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 of   
,labor 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 ,act1 including any          
whistleblower protections4  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
 the safe patient handling1 mobility1   
and injury prevention standard 7as      
initially promulgated under section #b  
of the ,nurse and ,health ,care ,worker 
,protection ,act of #bjae7 after        
redesignated72 and  7#b7 in subsection  
7b77#d7-- 7,a7 in subparagraph 7,a71 by 
inserting and the safe patient handling1
 mobility1 and injury prevention        
standard after ,bloodborne ,pathogens   
standard2 and  7,b7 in subparagraph     
7,b71 by 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 hospitals as of the  
date that is #a year after the date of  
issuance of the final safe patient      
handling1 mobility1 and injury          
prevention standard described in the    
second sentence of section #b7;a74  #d4 

,nonpreemption  7a7 ,effect on other    
laws ,nothing in this ,act shall be     
construed to-- 7#a7 preempt any law1    
including any rule or regulation1 of a  
,state or political subdivision of a    
,state1 unless such law is in conflict  
with this ,act or a regulation or order 
issued under this ,act2  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 ,act2  7#c7
 curtail or limit in any way the right  
of individuals with disabilities under  
the ,americans with ,disabilities ,act  
of #aiij 7#db ,u4,s4,c4 #abaja et seq47 
or section #ejd of the ,rehabilitation  
,act of #aigc 7#bi ,u4,s4,c4 #gid7 to   
those reasonable modifications needed to
 receive equal access to health care1   
including the requirement that health   
care employees give priority            
consideration to the lifting1 movement1 
or transfer needs and preferences of    

individuals with disabilities2 or  7#d7 
preempt or modify in any way the        
application of section #dd of the       
,internal ,revenue ,code of #aihf with  
respect to eligible access expenditures 
7as defined in section #dd7;c7 of such  
,code7 of an eligible small business 7as
 defined in section #dd7;b7 of such     
,code74  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 not less than 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 including    
health care workers1 employees who do   
not qualify as health care workers1 and 
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 clinic or          
rehabilitative center1 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