A couple of bills introduced in recent weeks would have significant impact on the health care industry. A bill introduced last week by Rep. John Conyers (D-MI) would require the establishment of a safe patient handling and injury prevention standard for direct-care registered nurses and other health care workers. The Nurse and Health Care Worker Protection Act of 2009 (H.R. 2381) would order the Secretary of Labor to propose a standard under the Occupational Safety and Health (OSH) Act within one year of the bill’s enactment. The final standard – which would, among other things, eliminate manual lifting of patients through the use of assistive patient handling equipment and other mechanical devices – would be issued within two years of this date.

At a minimum, the proposed standard – which applies to all healthcare employers – must ensure that covered employers:

• Develop and implement a safe patient handling and injury prevention plan within 6 months of the date of promulgation of the final standard, which includes hazard identification, risk assessments and control measures in relation to patient care duties and patient handling.
• Purchase, use, maintain and have accessible an adequate number of safe lift mechanical devices no later than 2 years after the date of issuance of a final regulation establishing such standard.
• Obtain input from direct-care registered nurses, health care workers and employee representatives of direct-care registered nurses and health care workers in developing and implementing the safe patient handling and injury prevention plan, including the purchase of equipment.
• 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 make such data and analyses available to employees and employee representatives.
• Establish a system to document each instance when safe patient handling equipment was not used due to legitimate concerns about patient care, and generate a written report in each such instance. These reports would need to be made available to OSHA compliance officers, workers and their representatives upon request within one business day.
• Train nurses and other health care workers on safe patient handling and injury prevention policies, equipment and devices at least on an annual basis.
• Post a uniform notice in a form specified by the Secretary of Labor that explains the safe patient handling and injury prevention standard, includes information regarding safe patient handling and injury prevention policies and training, and explains procedures to report patient handling-related injuries.
• Conduct an annual written evaluation of the implementation of the safe patient handling and injury prevention plan.

This bill would authorize the Secretary of Labor to perform inspections to ensure compliance with this new standard. A worker protected by the standard would be entitled to refuse an assignment if that job would subject the worker to conditions that would violate the safe patient handling and injury prevention standard, or if he or she had not received sufficient training as required by the Act. The bill includes anti-retaliatory, anti-discrimination and whistleblower protection provisions.

A direct-care registered nurse or health care worker who is fired, discriminated or retaliated against for exercising rights under this Act would have the ability to file a complaint with the Secretary of Labor. In addition, the aggrieved worker would have the right to bring a cause of action against the employer in federal court. Potential remedies under this Act include reinstatement, reimbursement of lost wages, compensation, benefits, attorneys’ fees, court costs and other damages.

For those health care facilities requiring financial assistance to comply with the proposed standard, the Act directs the Secretary of Health and Human Services to establish a grant program to assist with the purchase of necessary equipment.

This bill has been referred to the House Committees on Education and Labor, Energy and Commerce, and Ways and Means.

A second bill introduced by Rep. Janice Schakowsky (D-IL), the Nurse Staffing Standards for Patient Safety and Quality Care Act of 2009 (H.R. 2273), would, among other things, amend the Public Health Service Act to require that all hospitals develop and implement within two years of the bill's enactment staffing plans that meet newly established minimum direct care registered nurse-to-patient ratios, and adjust staffing numbers based on patient acuity levels and other considerations.

For instance, a hospital’s staffing plan must provide that during each shift within a unit of the hospital, a direct care registered nurse may be assigned – barring certain circumstances outlined in the bill – to no more than the following number of patients in that unit:

• 1 patient in operating room units and trauma emergency units.
• 2 patients in critical care units, including emergency critical care and intensive care units, labor and delivery units and post anesthesia units.
• 3 patients in antepartum units, emergency room units, pediatrics units, stepdown units and telemetry units.
• 4 patients in intermediate care nursery units, medical/surgical units and acute care psychiatric units.
• 5 patients in rehabilitation units.
• 6 patients in postpartum (3 couplets) units and well-baby nursery units.

The bill requires hospitals to post a uniform notice in each unit outlining the minimum nursing staff requirements, and to maintain records of actual direct care registered nurse-to-patient ratios in each unit for each shift for at least three years. In addition, this legislation contains worker protection provisions similar to those outlined in the Nurse and Health Care Worker Protection Act of 2009, including anti-retaliation and discrimination clauses, and a right to bring an action in federal court for violations.

This bill has been referred to the House Committees on Energy and Commerce and Ways and Means.