Bush administration relies on voluntary compliance from employers

by Susan Trossman, RN

After a year of promises, Department of Labor Secretary Elaine Chao finally announced the Occupational Safety and Health Administration's (OSHA) comprehensive plan for ergonomics protections for U.S. workers that relies on employers' voluntary compliance with the federal guidelines.

Although the first phase of the plan involves creating industry-specific ergonomic guidelines for nursing home workers, ANA and other organizations are far from satisfied. They say voluntary measures offer no real protection against serious work-related back and other musculoskeletal injuries that affect up to one third of all nurses.

"What we need are comprehensive regulations that are backed by government enforcement, not just boutique offerings that industry can pick and choose from," said ANA President Mary Foley, MS, RN.

ANA has long supported the establishment of an OSHA Ergonomics Standard spelling out rules that employers must follow, and was shocked when Congress voted in March 2001 to rescind a standard that had been finalized during the last days of the Clinton administration.

"The OSHA Ergonomics Standard was the most important federal effort to date to prevent disabling back injuries to health care workers," Foley said. "Since then, we have waited for Department of Labor Secretary Chao to fulfill her promise to pursue a comprehensive approach to ergonomics, so that nurses and all workers will be protected.

"We had a strict, enforceable standard that required employers to protect their workers from preventable injuries. Now, all we have are unenforceable 'best practice' suggestions that offer no real solutions to workplace injuries."

But ANA, other worker advocates and federal lawmakers are continuing their push for a strong ergonomics standard. To that end, Sens. John B. Breaux (D-LA) and Arlen Specter (R-PA) re-introduced federal legislation on April 17 that would require OSHA to issue a final standard within two years.

The legislation also would require the Department of Labor to include the entire ergonomics record collected since 1992 -- including previous ANA testimony -- when looking at how to develop the standard.

At an April 18 Senate committee hearing on ergonomics, Democrats also pushed for a mandatory ergonomics rule, stating that employers simply will ignore voluntary guidelines.

At that hearing, Chao, who was defending the concept of voluntary guidelines, announced that the Bush administration would start working with nursing home and other groups to develop comprehensive injury-prevention guidelines specific to long term care. When pressed by committee members for more details, Chao said those guidelines would be voluntary and that no deadline has been set for their release, according to ANA health and safety specialist Karen Worthington, MS, RN, COHN-S, who was present at the hearing.

Although OSHA's process for guideline development is unclear, ANA is eager to provide nursing's input into the nursing home measures, because they undoubtedly will serve as the model to address the same risky tasks that workers face in other health care settings, Worthington said.

In another development, OSHA Administrator John Henshaw announced the agency will begin inspecting nursing home and other personal care facilities that reported high rates of injury and illnesses as part of its National Emphasis Program. Henshaw decided to "re-energize" the program after meeting with ANA and health care worker union representatives who demanded OSHA attention to the high rate of injuries in this setting, Worthington said. Unfortunately, the program does not include investigating instances of workplace violence -- a key concern among health care workers who want a safe place to practice.

In other ANA action, UAN Vice Chair Ann Converso, RN, along with ANA staff and other unions, provided strategies on safe patient handling and movement at a Health Care Worker Unions in Health Care Conference held April 16 in Orlando, FL. Developed by the Department of Veterans Affairs, the strategies call for nurses and health care administrators to focus on the most dangerous tasks RNs perform, use effective transfer devices and reduce the number of times nurses lift and move patients.

For more information on the ergonomics issue, check ANA's "safety and health" Web page on www.NursingWorld.org. Also, see ANA's "Health and Safety" column in the June 2002 issue of the American Journal of Nursing.

Susan Trossman is the senior reporter for The American Nurse.