Hawaii-2012-SB1420-Introduced

SECTION 1. The legislature finds that research evidence demonstrates that registered nurses play a critical role in patient safety and quality of care. The shortage of nurses available to provide care in acute care hospitals has necessitated multiple strategies to generate more nurses and improve the recruitment and retention of nurses in hospitals.

Evidence-based nurse staffing that can help ensure quality and safe patient care while increasing nurse satisfaction in the work environment is essential to solving an urgent public health issue in Hawaii. Hospitals and nursing organizations recognize a mutual interest in patient safety initiatives that create a healthy environment for nurses and safe care for patients.

The purpose of this Act is to protect patients, support greater retention of registered nurses, and promote evidence‑based nurse staffing by establishing a mechanism whereby direct care nurses and hospital management participate in a joint process regarding decisions about nurse staffing.

SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

REGISTERED NURSE STAFFING LEVELS

§ -1 Definitions. For the purpose of this section, unless the context clearly requires otherwise:

"Acute care hospital" means a short-term hospital that has facilities, medical staff, and other personnel to provide diagnosis, care, and treatment of a wide range of acute conditions, including disease, trauma, or recovery from surgery. Acute care is usually given in a hospital by specialized personnel using complex and sophisticated technical equipment and materials, and it may involve intensive or emergency care.

"Critical access hospital" means a rural limited service hospital that has been specially designated as a critical access hospital under the medicare rural hospital flexibility grant program. A critical access hospital shall have no more than fifteen acute beds and ten swing beds, if desired; provided that the total compliment of acute care beds and swing beds shall not exceed twenty-five.

"Hospital" includes acute care hospitals, state hospitals, critical access hospitals, and psychiatric hospitals.

"Intensity" means the level of patient need for nursing care.

"Nurse" means a person licensed pursuant to chapter 457 to practice nursing. The term does not include licensed practical nurses or certified nursing assistants.

"Nurse staffing committee" means a committee established by a hospital under this chapter.

"Patient care unit" means any unit or area of the hospital that provides patient care by registered nurses.

"Registered nurse" means a person who practices as a registered nurse, as defined in section 457-2.5.

"Skill mix" means the number and percentage of registered nurses, licensed practical nurses, or unlicensed assistive personnel relative to the total number of nursing personnel.

§ -2 Nurse staffing committee. (a) No later than September 1, 2011, each acute care hospital and critical access hospital shall establish a nurse staffing committee, either by creating a new committee or assigning the functions of a nurse staffing committee to an existing committee, to develop a documented staffing plan as required pursuant to this chapter.

At least sixty per cent of the members of a nurse staffing committee shall be registered nurses currently providing direct patient care and forty per cent of the members shall be determined by the hospital administration. The selection of the registered nurses providing direct patient care on the staffing committee shall be according to the collective bargaining agreement, if applicable, or through selection by their peers.

Participation in the nurse staffing committee by a registered nurse shall be on scheduled work time and compensated at the appropriate rate of pay. Nurse staffing committee members shall be relieved of all other work duties during meetings of the committee.

(b) The primary responsibilities of the nurse staffing committee shall include the development and oversight of an annual patient care unit and shift-based nurse staffing plan, based on the needs of patients, to be used as a primary component of the staffing budget.

§ -3 Nurse staffing plan. (a) Factors to be considered in the development of the nurse staffing plan shall include:

(1) A census, including the total number of patients in the unit on each shift and activity such as patient discharges, admissions, and transfers;

(2) The level of intensity of all patients and nature of care to be delivered on each shift;

(3) The skill mix and classification of registered nurses required in each unit in the health care facility, which shall take into account the level of experience of the clinical and nonclinical support staff with whom the nurses collaborate, supervise, or otherwise delegate assignments;

(4) The need for specialized or intensive equipment or technology;

(5) The size and geography of each unit, including placement of patient rooms, treatment areas, nursing stations, medication preparation rooms, and equipment;

(6) Staffing guidelines adopted or published by national nursing professional associations, specialty nursing organizations, and other health professional organizations;

(7) Semi-annual review of the staffing plan in relation to patient need and known evidence-based staffing information, including the nursing-sensitive quality indicators collected by the hospital;

(8) Review, assessment, and response to staffing concerns presented to the committee; and

(9) Hospital finances and resources.

(b) Upon completion, the nurse staffing plan shall include, without limitation:

(1) A detailed written plan setting forth the number, skill mix, and classification of registered nurses in each hospital unit, which shall take into account the experience of the clinical and nonclinical support staff with whom the nurses supervise, collaborate, or otherwise delegate assignments;

(2) A description of the types of patients who are treated in each unit, including, without limitation, discharges, transfers, and admissions;

(3) A description of the size and geography of each unit;

(4) A description of any specialized equipment and technology available for each unit; and

(5) Any foreseeable changes in the size or function of each patient care unit.

If the nurse staffing plan is not adopted and documented by the hospital, the hospital administration shall provide to the committee a written explanation of the reasons why the plan was not adopted, and the hospital administration shall be given an opportunity to address the reasons why the plan was not adopted.

(c) The nurse staffing plan shall not diminish other standards contained in state or federal law or rules or the terms of an applicable collective bargaining agreement, if any, between the hospital and the exclusive representative of the registered nursing staff.

(d) Each hospital shall post, in a public area on each patient care unit, the nurse staffing plan and the nurse staffing schedule for that shift on that unit, as well as the relevant clinical staffing for that shift. The staffing plan and current staffing levels shall also be made available to patients and visitors upon request.

(e) A hospital may not retaliate or engage in any form of intimidation of:

(1) An employee for performing any duties or responsibilities in connection with the nurse staffing committee; or

(2) An employee, patient, or other individual who notifies the nurse staffing committee or the hospital administration of their concerns on nurse staffing.

(f) This section is not intended to create unreasonable burdens on critical access hospitals under Title 42 United States Code Section 1395. Critical access hospitals may develop flexible approaches to accomplish the requirements of this section that may include having nurse staffing committees work by telephone, video conferencing, or electronic mail.

§ -4 Licensure. As a condition of licensing, acute care and critical access hospitals shall make available to the department of health a documented nurse staffing plan and a written certification that the documented nurse staffing plan is adequate to meet the needs of patients in the hospital."

SECTION 3. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	1420
TWENTY-SIXTH LEGISLATURE, 2011
STATE OF HAWAII