Getting a lift

While nurses gain protection with ‘safe handling’ law, hospitals stepped in to make it business-friendly

"Oh my aching back."

That appears to be a common complaint among caregivers at hospitals. In fact, according to a 2003 Department of Labor and Industries study, nursing staff have among the highest back injury rates of any occupational group in Washington State. In response to this situation, a new Washington law goes into effect June 7. Known as the "safe patient handling bill," H.B. 1672 seeks to prevent staff and patient injuries due to patient lifting. Only Texas and New York have similar laws in place.

"I’m really excited about this bill," said Vicki Wornath, who is a registered nurse at Southwest Washington Medical Center.

The bill will require hospitals to provide mechanical lifts for the purpose of moving patients, and also requires hospitals to form a safe patient handling committee, of which half the members must be "frontline nonmanagerial employees" – i.e., nurses. According to Wornath, it is imperative that nurses have input on patient care – such as helping the committee choose equipment and form lifting procedures.

Although nurses have supported the new law since its inception last year, the Washington State Hospital Association opposed the law at first, claiming it created an "unfunded mandate" and was too vague and restrictive. However, WSHA worked with the legislature to make last-minute changes to the bill during the six weeks prior to its passage. These changes include:
• reducing estimated fiscal impact over the next four years from $229 million to $6 million.
• adding a Business & Occupation tax credit and reducing workers’ compensation premiums for compliant hospitals.
• changing the wording from a vague "no manual lift policy" (which WSHA said was unrealistic) to a more clearly defined equipment and training standard.
• changing the regulating agency from L&I to the Washington State Department of Health.

Cassie Sauer, a spokesperson for WSHA, said that although the bill started off contentious, it ended up "with everybody happy." She especially expressed satisfaction that the legislature recognized that "hospitals cannot continue to absorb huge unfunded mandates."

Some hospital officials, however, doubt whether the legislation was needed at all.

"Every hospital I know is already using lifts," said Mike Madden, chief executive officer of the 24-bed Skyline Hospital in White Salmon. "If you’re already doing something, why do you need another piece of legislation to tell you to do it?"

Skyline, said Madden, was equipped with mobile lifts and offered routine training to nurses in how to use them. Scott Laubisch, regional vice president for Business Development and Public Relations at Longview’s PeaceHealth St. John Medical Center said that St. John’s has already incorporated patient lifts at bedside, uses mobile lifts in the emergency room, already has a safe patient handling committee and budgeted for lifts in their five-year, $46 million renovation of their patient tower, begun in 2005.

"It will cost us several million to do," said Laubisch, "but it is in the best interest of our patients and staff."

Jamie Meador, employee health manager for Southwest Washington Medical Center, reported that SWMC’s 2005 capital budget included planning for ceiling lifts, and that SWMC’s goal is to have one in every room. The new patient tower, scheduled to open in the near future, is "lift-ready" as well. Lynn Crawford, clinical manager at SWMC, estimates that it costs $8,000 to $10,000 to retrofit a private room, and about $10,000 to $12,000 for a double room. These costs will be offset by sections of the bill that offer a $1,000 per available acute care inpatient bed B&O tax deduction, and a reduced worker’s compensation premium (the exact reduction is to be decided by Jan. 1, 2007). But still, said Madden, the cost of lifts and lift training will have to be passed on to the consumer, making hospital stays even more expensive.

Nurse and patient demographics are the driving factors behind why lifts are becoming crucial. As of 2004, the average age of the RN population was about 46.8 years of age, and has increased steadily each year since 1980, when only 17.2 percent of nurses were over 54 years of age. In 2004, that figure had grown to 25.5 percent. Combine an aging nursing population with an obese patient population – ­an estimated 64 percent of Americans are overweight or obese – and it’s a recipe for back injuries.

These statistics make the costs of not installing lifts outweigh installation costs. L&I estimates that using lifts could save the state up to $17.4 million per year in workers’ compensation claims related to work-related musculoskeletal disorders. In a pilot project at a Portland Legacy facility, said Rob Strickland, ergonomics coordinator for Legacy Salmon Creek Hospital, they saw an 83 percent decrease in injury incidence over a two-year period after installing lifts.

In other words, said Strickland, hospitals are implementing lifts because they "make sense," not because "someone is telling us to."