Federal Requirements for the Nurse Call/Pull Cords

Hospitals, nursing homes and other healthcare facilities have protocols in place for patient emergencies. One of those protocols is responding immediately to a patient or resident who pulls a nurse call/pull cord. These cords are commonly found in bathrooms and near patients' beds, two places where people are commonly alone and may need assistance. When located in public facilities, such as hospitals, nurse call/pull cords must meet federal requirements under the Americans with Disabilities Act. They typically also must comply with standards required by various other advisory bodies.

ADA Requirements

The ADA does not specifically mention nurse call/pull cord requirements. What it does make mandatory are reach requirements for patients who sit in wheelchairs. That means the nurse call system must be mounted at a height that someone sitting in a wheelchair can reach. The ADA mandates that an accessible element, such as a nurse call system, must be mounted no higher than 48 inches from the ground for spaces that only allow forward reach. For spaces that allow side reach, the maximum allowable height is 54 inches. Not complying with the ADA requirements can result in penalties and fines. The ADA does not have any length requirements for pull cords.

These regulations and various other standards are the minimum that healthcare providers are required to meet. States can set more stringent standards as they deem necessary. For example, while there are no federal nurse call/pull cord length requirements, Georgia requires pull cords to extend to within 4 inches of, but not touch, the floor when placed in bathrooms in healthcare facilities.

National Fire Protection Association Standards

The National Fire Protection Association has a nationally recognized and adapted Health Care Facilities Code NFPA 99 that covers nurse call/pull cord requirements. NFPA 99 applies to all facilities that provide healthcare and medical services, including psychiatric units and geriatric units. Under NFPA 99, each patient bed and bath is required to have a call station. Call stations in the bathroom must be accessible to someone lying on the floor.

Nurse call systems in units housing patients suffering from dementia must be tamper resistant with pull strings of no more than 6 inches long. Nurse call stations in psychiatric units must also be tamper resistant and are not permitted to have any pull strings or cords. NFPA 99 also makes provisions for notification signals from an activated nurse call system. When a patient pulls the cord on a nurse call system, there must be a visual signal in the hallway closest to the patient’s room or at a hallway intersection if the room isn’t directly visible to the nurses. There must also be visual and audible signals at nurses' stations.

UL Standards

UL is a safety consulting and certification company that has established industry standards for nurse call/pull cords. The standards are widely adapted and account for the more technical specifications of installing nurse call/pull cords. UL has two standards that address nurse call/pull cord requirements: UL 1069 Hospital Signaling and Nurse Call Equipment and UL 2650 Emergency Call Systems for Assisted Living and Independent Living Facilities.

UL does not establish nurse call/pull cord length requirements. It maintains that call cords must have visual and audible signals at the nurse’s station when removed from the electric socket accidentally.


  • The Americans with Disabilities Act (ADA) requires nurse call/pull cord units to be accessible to people in wheelchairs and establishes mandatory height limits.

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