Washington State passed Safe Patient Handling legislation (ESHB 1672) for hospitals in 2006 with full implementation by 2010. We assessed the impact of the legislation by comparing workers compensation claims rates for Washington State hospitals (with) nursing homes (without) over this period, focusing on work-related musculoskeletal disorders (WMSDs). We also compared implementation of SPH in Washington State hospitals (with legislation) to comparable hospitals in Idaho (no legislation) via focus groups and surveys. Over the study period, hospital WC rates for WMSDs declined more rapidly than nursing home WC rates. Washington hospital nursing staff reported significantly greater SPH implementation than Idaho nursing staff.