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New bill aims to eliminate manual lifting

January 5, 2016
by Steve Wilder, CHSP, STS
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A new bill proposed by Representative John Conyers (D-Mich) and Senator Al Franken (D-Minn) is drawing support and accolades from the American Nurses Association (ANA). The Nurse and Health Care Worker Protection Act, reintroduced in 2015 as H.R. 4266, would establish a national occupational safety standard that would eliminate the manual lifting of patients by registered nurses (RNs) and healthcare workers through the use of modern technology and safety controls. Additionally, healthcare employers would be required to implement a comprehensive safe patient handling and mobility program and to train their workers in proper use and practices .

"Every day, nurses and other healthcare workers suffer debilitating and often career-ending musculoskeletal disorders when they manually lift or move patients, and work in pain," said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, President of the ANA, in an ANA statement. "Manual lifting is an unacceptable risk and practice when we have the technology and knowledge to significantly reduce injuries. This bill signals that workers are not expendable and injuries are not tolerable as just 'part of the job.' It is a much needed step in the right direction to implementing safer programs that will help to save and extend the careers of thousands of registered nurses."

And while most would agree that the bill is noble conceptually, not everyone agrees that it will do what it is intended to do.

"Not all residents are going to be receptive to having an assist device used on them," Bob Royland of the Illinois Nursing Home Administrators Association told me. "When you're working with Alzheimer’s and dementia residents, they don't adapt well to change, and it's not as easy as just explaining it to them.  Many are adamant about what they want and don’t want.  When they become physically resistant, then what do you do?"

His concerns are valid. In many of the facilities I visit, I identify the presence of assistive devices, but many seem to be seldom used. "It's not that we don't want to use them," one nurse told me, "it's that we don't have enough of them, and many times the residents complain of feeling scared and vulnerable when they're sitting in the sling."

Regulatory agencies may not all be on the same page on the issue, either. While everyone involved in safety management and risk management are looking for ways to maximize health and safety for workers, resident rights advocates may see things through a different set of lenses. And, as more and more initiatives focus on involving the resident in the decision-making processes on all aspects of their care, is the healthcare provider going to be stuck in between a federal mandate that says assistive devices must be used and a resident who says "don’t use those on me!"?

Consistently, I get feedback from healthcare providers reminding me that they know their residents and they know how to manage them. That is a fair and reasonable statement. At the same time, the numbers of debilitating injuries to healthcare professionals as result of lifting injuries continues to skyrocket, leading me to think that maybe we're not as smart as we think we are. One thing that is for certain: there is no easy answer.




I support efforts to reduce staff injury attributed to lifting. While lifting devices, as currently designed, are beneficial for staff injury prevention, the use of these devices sometimes has very untoward effects which aren't being considered. I've seen numerous geriatric patients who entered a hospitalization or SNF stay able to transfer with minimal assistance quickly lose transfer ability and become totally dependent for transferring even though all else has returned to baseline. Many times this transfer ability is not regained even with the spurts of Physical Therapy provided. There is an often permanent toll taken on the individual which the institution doesn't consider. Often the patient was initially capable of a safe transfer but due to facility policy mandating the use of the device, staff insist on the lift and the patient quickly becomes debilitated, dependent and loses confidence in their transfer ability. And by the way, patients/patient families aren't given a choice. They are sternly informed this is hospital/facility policy.

It would be great if there was a lift that worked easily that would help out in any situation. Unfortunately, that is not true.
The first time I was in a Hoyer lift was when I was in the hospital with cellulitis on my right leg. I stand to transfer with assistance but they would not let me. They had to use the lift. The aide who operated it was either not familiar with proper use or careless – because I ended up being lowered quickly to my bed because the lift was not attached and working properly. That was scary.
I also previously lived at a nursing home which "tried out" the no physical lifting rule. I was told I had to be lifted with a Hoyer. While the nurses and aides knew how to use it, it was ungainly, and took a lot of time. The lift was not able to get me back far enough in my power chair to be comfortable and functional. The aides had to pull me up in my power chair after using the lift.
Several of them told me their backs hurt more from pulling me up then from allowing me to stand and transfer using my legs to push as they pulled me up in my power chair. We ended up having a real battle of wills. The aides did not want to use the lift and they told the Dir. of Nursing that the procedure needed to be changed. But it was not.
I think there has to be a meeting of the minds so that both management and staff know what works. The aides do most of the work with residents and they know – at least the good aides – what works best.



Steve Wilder

Steve Wilder


Steve Wilder, CHSP, STS, is president and chief operating officer of...