Bill Text: CA SB554 | 2011-2012 | Regular Session | Amended
Bill Title: Health facilities: direct care nurses.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2012-01-11 - Returned to Secretary of Senate pursuant to Joint Rule 62(a). [SB554 Detail]
Download: California-2011-SB554-Amended.html
BILL NUMBER: SB 554 AMENDED
BILL TEXT
AMENDED IN SENATE JANUARY 4, 2012
INTRODUCED BY Senator Yee
FEBRUARY 17, 2011
An act to amend Section 1279 of, and to add
Section 1280.7 to, 1276.45 to the
Health and Safety Code, relating to health facilities.
LEGISLATIVE COUNSEL'S DIGEST
SB 554, as amended, Yee. Health facilities:
nurse-to-patient ratios. direct care nurses.
Under existing law, the Board of Registered Nursing in the
Department of Consumer Affairs regulates the licensing of registered
nurses. Existing law requires the State Department of Public Health
to license and regulate health facilities, including hospitals, and
establish minimum hospital nurse-to-patient ratios by licensed nurse
classification and by hospital unit. Under existing law, specified
hospitals are required to adopt written policies and procedures for
training and orientation of nursing staff. These provisions prohibit
a registered nurse from being assigned to a nursing unit or clinical
area until that nurse has received the specified orientation and
demonstrated sufficient competency. A violation of these health
facility provisions is a crime.
This bill would require each direct care registered nurse to
receive and complete an orientation to the hospital and patient care
unit in which he or she will be working and to have demonstrated
competency, as specified. It would preclude a nurse who has not
completed this orientation and had validation of competency from
being assigned direct patient care. This bill would specify that,
until the nurse completes orientation and has validation of
competency, he or she would not be counted as staff in computing the
nurse-to-patient ratio. This bill would exempt a state inpatient
mental health hospital, a state developmental center, a state
veterans' home, or a state correctional institution from those
provisions of the bill requiring specified observation of the nurse.
By creating a new crime, this bill would impose a state-mandated
local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Existing law provides for the regulation and inspection of health
facilities by the State Department of Public Health. Existing law
requires the department, with regard to general acute care hospitals,
acute psychiatric hospitals, and special hospitals, to adopt
regulations that establish certain minimum nurse-to-patient ratios,
and requires these health facilities to adopt written policies and
procedures for training and orientation of nursing staff. Violation
of these provisions is a misdemeanor.
This bill would specifically include an inspection for compliance
with the nurse-to-patient ratio requirements within an inspection for
compliance with existing regulations. The bill would require an
inspection for compliance with a filed plan of correction for a
hospital notified of a deficiency in compliance with the
nurse-to-patient ratio requirements and would require the imposition
of administrative penalties, as specified. It would require the
notice of deficiency regarding the nurse-to-patient ratio
requirements, as well as an approved plan of correction, to be posted
in the nurses' station or designated nurses' area of the unit of the
health facility where the deficiency occurred.
By creating new crimes, this bill would impose a state-mandated
local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1276.45 is added to the
Health and Safety Code , to read:
1276.45. (a) Each general acute care hospital, acute psychiatric
hospital, and special hospital, as defined in subdivisions (a), (b),
and (f) of Section 1250, shall ensure that all direct care registered
nurses, including new hires, casual, per diem, temporary agency,
registry, and traveler staff, shall receive and complete orientation
to the hospital and patient care unit or clinical care area in which
they will be working. All health facilities subject to this section
shall adopt written policies and procedures for the training and
orientation of nursing staff.
(b) (1) Every direct care registered nurse shall have current
demonstrated and validated competency required for the specific
individual needs of the patient population admitted to the unit or
clinical area before being assigned to patient care for that unit or
clinical area. In accordance with paragraph (2), current competency
may only be demonstrated and validated by the direct observation of
the orientee by another direct care registered nurse who has
previously demonstrated current competency in the relevant patient
population. Self-assessments are prohibited.
(2) This paragraph applies to only temporary agency, registry, and
traveler staff registered nurses. The observing direct care
registered nurse shall be required to directly observe and assess the
orientee within the relevant clinical area and with the relevant
patient population for a minimum of five standard nursing shifts in
order to determine if the orientee displays the required knowledge,
performance, and skills of patient assessment, patient care planning,
education, intervention, patient evaluation, and patient advocacy to
satisfactorily fulfill the duties required by the Nursing Practice
Act (Chapter 6 (commencing with Section 2700) of Division 2 of the
Business and Professions Code) and the Standards of Competent
Performance.
(c) The written policies and procedures for the orientation of
nursing staff shall require that all temporary personnel shall
receive orientation and be subject to validation of demonstrated
competency consistent with the requirements of this section and with
Sections 70016.1 and 70214 of Title 22 of the California Code of
Regulations.
(d) An orientee shall not be included in the calculation of the
licensed nurse-to-patient ratio required by Section 1276.4.
(e) As used in this section, "orientee" means a direct care
registered nurse who has not received and completed orientation to
the hospital and patient care unit or clinical area and whose current
competency has not been demonstrated and validated.
(f) Paragraph (2) of subdivision (b) shall not apply to a state
inpatient mental health hospital, as identified in Section 4100 of
the Welfare and Institutions Code, a state developmental center, as
identified in Section 4440 of the Welfare and Institutions Code, a
state veterans' home, as defined in Chapter 1 (commencing with
Section 1010) of Division 5 of the Military and Veterans Code, or a
correctional institution operated by the State Department of
Corrections and Rehabilitation pursuant to Title 7 (commencing with
Section 5000) of Part 3 of the Penal Code.
SECTION 1. Section 1279 of the Health and
Safety Code is amended to read:
1279. (a) Every health facility for which a license or special
permit has been issued shall be periodically inspected by the
department, or by another governmental entity under contract with the
department. The frequency of inspections shall vary, depending upon
the type and complexity of the health facility or special service to
be inspected, unless otherwise specified by state or federal law or
regulation. The inspection shall include participation by the
California Medical Association consistent with the manner in which it
participated in inspections, as provided in Section 1282 prior to
September 15, 1992.
(b) Except as provided in subdivision (c), inspections shall be
conducted no less than once every two years and as often as necessary
to ensure the quality of care being provided.
(c) For a health facility specified in subdivision (a), (b), or
(f) of Section 1250, inspections shall be conducted no less than once
every three years, and as often as necessary to ensure the quality
of care being provided.
(d) During the inspection, the representative or representatives
shall offer such advice and assistance to the health facility as they
deem appropriate.
(e) For acute care hospitals of 100 beds or more, the inspection
team shall include at least a physician, registered nurse, and
persons experienced in hospital administration and sanitary
inspections. During the inspection, the team shall offer advice and
assistance to the hospital as it deems appropriate.
(f) The department shall ensure that a periodic inspection
conducted pursuant to this section is not announced in advance of the
date of inspection. An inspection may be conducted jointly with
inspections by entities specified in Section 1282. However, if the
department conducts an inspection jointly with an entity specified in
Section 1282 that provides notice in advance of the periodic
inspection, the department shall conduct an additional periodic
inspection that is not announced or noticed to the health facility.
(g) Notwithstanding any other law, the department shall inspect
for compliance with state law, including, but not limited to, Section
1276.4, and regulations during a state periodic inspection or at the
same time as a federal periodic inspection, including, but not
limited to, an inspection required under this section. If a health
facility has been notified of a deficiency in its compliance with
Section 1276.4 and the health facility files a plan of correction,
the department shall also inspect for compliance with this plan of
correction. If the department inspects for compliance with state law
and regulations at the same time as a federal periodic inspection,
the inspection shall be done consistent with the guidance of the
federal Centers for Medicare and Medicaid Services for the federal
portion of the inspection.
(h) The department shall emphasize consistency across the state
and its district offices when conducting licensing and certification
surveys and complaint investigations, including the selection of
state or federal enforcement remedies in accordance with Section
1423. The department may issue federal deficiencies and recommend
federal enforcement actions in those circumstances where they provide
more rigorous enforcement action.
SEC. 2. Section 1280.7 is added to the Health
and Safety Code, to read:
1280.7. (a) If a health facility has been notified of a
deficiency in its compliance with Section 1276.4, the notice of
deficiency, along with an approved plan of correction, shall be
posted in the nurses' station or designated nurses' area of the unit
of the health facility where the deficiency occurred until the
department determines that the health facility has complied with the
approved plan of correction.
(b) (1) Notwithstanding Section 1280.3, the department shall
assess an administrative penalty in the amount of ten thousand
dollars ($10,000) for the fourth and for each subsequent violation of
Section 1276.4 within a continuous six-month period.
(2) Notwithstanding Section 1280.3, and in addition to an
administrative penalty assessed pursuant to paragraph (1), the
department shall also assess an administrative penalty in the amount
of ten thousand dollars ($10,000) for the failure of a health
facility to comply with an approved plan of correction filed with the
department in response to a deficiency in compliance with Section
1276.4.
(c) Moneys collected by the department as a result of
administrative penalties imposed under this section shall be
deposited in the Licensing and Certification Program Fund established
pursuant to Section 1266.9. These moneys shall be tracked and
available for expenditure, upon appropriation by the Legislature, to
support internal departmental quality improvement activities.
SEC. 3. SEC. 2. No reimbursement is
required by this act pursuant to Section 6 of Article XIII B of the
California Constitution because the only costs that may be incurred
by a local agency or school district will be incurred because this
act creates a new crime or infraction, eliminates a crime or
infraction, or changes the penalty for a crime or infraction, within
the meaning of Section 17556 of the Government Code, or changes the
definition of a crime within the meaning of Section 6 of Article XIII
B of the California Constitution.
