Bill Text: IA HF31 | 2013-2014 | 85th General Assembly | Introduced
Bill Title: A bill for an act relating to patient safety by establishing a nurse staffing plan, a collaborative nurse staffing committee, a patient safety committee, and reporting for nurses, and including effective date provisions.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2013-12-31 - END OF 2013 ACTIONS [HF31 Detail]
Download: Iowa-2013-HF31-Introduced.html
House
File
31
-
Introduced
HOUSE
FILE
31
BY
HUNTER
A
BILL
FOR
An
Act
relating
to
patient
safety
by
establishing
a
nurse
1
staffing
plan,
a
collaborative
nurse
staffing
committee,
2
a
patient
safety
committee,
and
reporting
for
nurses,
and
3
including
effective
date
provisions.
4
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
5
TLSB
1228YH
(2)
85
ad/nh
H.F.
31
DIVISION
I
1
NURSE
STAFFING
AND
COLLABORATIVE
NURSE
STAFFING
COMMITTEES
2
Section
1.
NEW
SECTION
.
135P.1
Definitions.
3
1.
“Acuity”
means
the
measure
of
a
patient’s
severity
of
4
illness
or
medical
condition
including
but
not
limited
to
the
5
stability
of
physiological
and
psychological
parameters
and
the
6
dependency
needs
of
the
patient
and
the
patient’s
family.
7
2.
“Department”
means
the
department
of
inspections
and
8
appeals.
9
3.
“Hospital”
means
the
same
as
defined
in
section
135B.1.
10
5.
“Mental
health
institute”
means
a
mental
health
institute
11
as
described
in
chapter
226.
12
4.
“Mental
illness”
means
a
substantial
disorder
of
thought
13
or
mood
which
significantly
impairs
judgment,
behavior,
or
the
14
capacity
to
recognize
reality
or
the
ability
to
cope
with
the
15
ordinary
demands
of
life.
16
6.
“Nursing
care”
means
those
services
which
can
be
provided
17
only
under
the
direction
of
a
registered
nurse
or
a
licensed
18
practical
nurse.
19
7.
“Nursing
facility”
means
the
same
as
defined
in
section
20
135C.1.
21
8.
“Rehabilitative
services”
means
services
to
encourage
and
22
assist
restoration
of
optimum
mental
and
physical
capabilities
23
of
the
individual
resident
of
a
health
care
facility.
24
9.
“Resident”
means
an
individual
admitted
to
a
health
care
25
facility
in
the
manner
prescribed
by
section
135C.23.
26
10.
“School
nurse”
means
a
person
who
holds
an
endorsement
27
or
a
statement
of
professional
recognition
for
school
nurses
28
issued
by
the
board
of
educational
examiners.
29
11.
“Supervision”
means
oversight
and
inspection
of
the
act
30
of
accomplishing
a
function
or
activity.
31
Sec.
2.
NEW
SECTION
.
135P.2
Hospital
nurse
staffing
plan
32
and
standards.
33
1.
A
hospital
shall
approve,
implement,
and
comply
with
a
34
direct
care
registered
nurse
staffing
plan
developed
by
the
35
-1-
LSB
1228YH
(2)
85
ad/nh
1/
19
H.F.
31
hospital’s
collaborative
nurse
staffing
committee
established
1
pursuant
to
section
135P.4.
The
plan
shall
provide
for
the
2
adequate,
appropriate,
and
quality
delivery
of
health
care
3
services
and
protect
patient
safety.
4
2.
Except
as
otherwise
provided
in
this
section,
a
5
hospital’s
staffing
plan
shall
provide
that,
at
all
times
6
during
each
shift
within
a
unit
of
the
hospital,
a
direct
care
7
registered
nurse
may
be
assigned
to
not
more
than
the
following
8
number
of
patients
in
the
specified
unit:
9
a.
One
patient
in
a
trauma
emergency
unit.
10
b.
One
patient
in
an
operating
room
unit,
provided
that
at
11
least
one
additional
person
serves
as
a
scrub
assistant
in
such
12
unit.
13
c.
Two
patients
in
a
critical
care
unit,
including
neonatal
14
intensive
care
units,
emergency
critical
care
and
intensive
15
care
units,
labor
and
delivery
units,
coronary
care
units,
16
acute
respiratory
care
units,
postanesthesia
units,
and
burn
17
units.
18
d.
Three
patients
in
an
emergency
room
unit,
pediatrics
19
unit,
stepdown
unit,
or
combined
labor,
deliver,
and
postpartum
20
unit.
21
e.
Four
patients
in
a
medical-surgical
unit,
intermediate
22
care
nursery
unit,
acute
care
psychiatric
unit,
or
other
23
specialty
care
unit.
24
f.
Five
patients
in
a
rehabilitation
unit
or
skilled
nursing
25
unit.
26
g.
Six
patients
in
a
postpartum
unit
or
well-baby
nursery
27
unit.
28
3.
The
department
may
apply
minimum
direct
care
registered
29
nurse-to-patient
ratios
established
in
subsection
2
for
a
30
hospital
unit
referred
to
in
that
subsection
to
a
type
of
31
hospital
unit
not
referred
to
in
that
subsection
if
the
32
hospital
unit
provides
a
level
of
care
to
patients
whose
needs
33
are
similar
to
the
needs
of
patients
cared
for
in
the
hospital
34
unit
referred
to
in
that
subsection.
35
-2-
LSB
1228YH
(2)
85
ad/nh
2/
19
H.F.
31
4.
In
developing
the
staffing
plan,
the
collaborative
nurse
1
staffing
committee
shall
provide
for
direct
care
registered
2
nurse-to-patient
ratios
above
the
minimum
ratios
provided
in
3
subsection
2,
if
appropriate,
based
upon
consideration
of
the
4
following
factors:
5
a.
The
number
of
patients
and
acuity
level
of
patients
6
as
determined
by
the
application
of
an
acuity
system,
on
a
7
shift-by-shift
basis.
8
b.
The
anticipated
admissions,
discharges,
and
transfers
of
9
patients
during
each
shift
that
impact
direct
patient
care.
10
c.
Specialized
experience
required
of
direct
care
registered
11
nurses
on
a
particular
unit.
12
d.
Staffing
levels
and
services
provided
by
licensed
13
vocational
or
practical
nurses,
licensed
psychiatric
14
technicians,
certified
nurse
assistants,
or
other
ancillary
15
staff
in
meeting
direct
patient
care
needs
not
required
by
a
16
direct
care
registered
nurse.
17
e.
The
level
of
technology
available
that
affects
the
18
delivery
of
direct
patient
care.
19
f.
The
level
of
familiarity
with
hospital
practices,
20
policies,
and
procedures
by
temporary
agency
direct
care
21
registered
nurses
used
during
a
shift.
22
g.
Obstacles
to
efficiency
in
the
delivery
of
patient
care
23
presented
by
physical
layout.
24
h.
Other
information
relevant
to
patient
care.
25
5.
This
section
shall
not
be
construed
as
a
prohibition
26
on
a
hospital’s
ability
to
set
standards
that
are
at
least
27
equivalent
to
the
requirements
under
this
section.
28
6.
a.
A
hospital
shall
not
average
the
number
of
patients
29
and
the
total
number
of
direct
care
registered
nurses
assigned
30
to
patients
in
a
hospital
unit
during
any
one
shift
or
over
any
31
period
of
time
for
purposes
of
meeting
the
requirements
under
32
this
section.
33
b.
A
hospital
shall
not
impose
mandatory
overtime
34
requirements
to
meet
the
hospital
unit
direct
care
registered
35
-3-
LSB
1228YH
(2)
85
ad/nh
3/
19
H.F.
31
nurse-to-patient
ratios
required
under
this
section.
1
c.
A
hospital
shall
ensure
that
only
a
direct
care
2
registered
nurse
may
relieve
another
direct
care
registered
3
nurse
during
breaks,
meals,
and
other
routine,
expected
4
absences
from
a
hospital
unit.
5
d.
A
hospital
shall
not
encroach
on
the
scope
of
practice
of
6
a
direct
care
registered
nurse.
A
hospital
shall
not
require
a
7
direct
care
registered
nurse
to
train
a
replacement
if
doing
so
8
would
compromise
patient
safety.
9
e.
A
hospital
shall
establish
a
system
to
document
actual
10
staffing
in
each
unit
for
each
shift.
11
f.
To
the
extent
appropriate
based
on
the
staffing
plan
in
12
each
unit
in
relation
to
actual
patient
care
requirements
and
13
the
accuracy
of
the
acuity
system,
a
hospital
shall
annually
14
approve
updates
to
the
nurse
staffing
plan
developed
by
the
15
collaborative
nurse
staffing
committee.
16
g.
Once
developed,
a
hospital
shall
conspicuously
post
17
the
required
staffing
levels
for
each
unit
in
the
unit
and
in
18
waiting
areas.
The
postings
must
be
visible
to
hospital
staff,
19
patients,
and
the
public.
20
7.
A
hospital
shall
not
discipline
a
direct
care
registered
21
nurse
for
refusing
to
accept
an
assignment
if,
in
good
faith
22
and
in
the
nurse’s
professional
judgment,
the
nurse
determines
23
that
the
assignment
is
unsafe
for
patients
due
to
patient
24
acuity
and
nursing
intensity.
25
8.
The
requirements
established
in
this
section
shall
not
26
apply
during
a
state
of
emergency
if
a
hospital
is
requested
or
27
expected
to
provide
an
exceptional
level
of
emergency
or
other
28
medical
services.
29
9.
The
requirements
established
in
subsections
2,
3,
30
and
6
do
not
apply
to
entities
designated
as
critical
access
31
hospitals
pursuant
to
42
U.S.C.
§
1395i-4.
The
nurse
staffing
32
plan
at
a
critical
access
hospital
shall
follow
the
standards
33
set
in
subsections
2,
3,
and
6
as
is
reasonable
based
on
the
34
hospital’s
needs
and
capabilities.
35
-4-
LSB
1228YH
(2)
85
ad/nh
4/
19
H.F.
31
10.
The
department
may
sanction
a
hospital
for
failure
to
1
comply
with
this
section,
including
failure
to
staff
patient
2
care
units
at
levels
required
in
its
staffing
plan.
3
11.
The
department
may
adopt
rules
to
enforce
this
section.
4
Sec.
3.
NEW
SECTION
.
135P.3
Nursing
facility
and
mental
5
health
institute
nurse
staffing
plan
and
standards.
6
1.
A
nursing
facility
or
mental
health
institute
shall
7
approve,
implement,
and
comply
with
a
direct
care
registered
8
nurse
staffing
plan
developed
by
the
facility’s
or
institute’s
9
collaborative
nurse
staffing
committee
established
pursuant
10
to
section
135P.4.
The
plan
shall
provide
for
the
adequate,
11
appropriate,
and
quality
delivery
of
health
care
services
and
12
protect
patient
safety.
13
2.
In
developing
the
staffing
plan,
the
collaborative
nurse
14
staffing
committee
shall
provide
for
direct
care
registered
15
nurse-to-patient
ratios
based
upon
consideration
of
the
16
following
factors:
17
a.
The
number
of
patients
and
acuity
level
of
patients
18
as
determined
by
the
application
of
an
acuity
system,
on
a
19
shift-by-shift
basis.
20
b.
The
anticipated
admissions,
discharges,
and
transfers
of
21
patients
during
each
shift
that
impact
direct
patient
care.
22
c.
Specialized
experience
required
of
direct
care
registered
23
nurses
on
a
particular
unit.
24
d.
Staffing
levels
and
services
provided
by
licensed
25
vocational
or
practical
nurses,
licensed
psychiatric
26
technicians,
certified
nurse
assistants,
or
other
ancillary
27
staff
in
meeting
direct
patient
care
needs
not
required
by
a
28
direct
care
registered
nurse.
29
e.
The
level
of
technology
available
that
affects
the
30
delivery
of
direct
patient
care.
31
f.
The
level
of
familiarity
with
the
nursing
facility’s
or
32
mental
health
institute’s
practices,
policies,
and
procedures
33
by
temporary
agency
direct
care
registered
nurses
used
during
a
34
shift.
35
-5-
LSB
1228YH
(2)
85
ad/nh
5/
19
H.F.
31
g.
Obstacles
to
efficiency
in
the
delivery
of
patient
care
1
presented
by
physical
layout.
2
h.
Other
information
relevant
to
patient
care.
3
3.
a.
A
nursing
facility
or
mental
health
institute
4
shall
not
average
the
number
of
patients
and
the
total
number
5
of
direct
care
registered
nurses
assigned
to
patients
in
a
6
nursing
facility
or
mental
health
institute
unit
during
any
one
7
shift
or
over
any
period
of
time
for
purposes
of
meeting
the
8
requirements
of
a
direct
care
registered
nurse
staffing
plan
9
developed
pursuant
to
this
section.
10
b.
A
nursing
facility
or
mental
health
institute
shall
not
11
impose
mandatory
overtime
requirements
to
meet
the
nursing
12
facility
or
mental
health
institute
unit
direct
care
registered
13
nurse-to-patient
ratios
required
by
a
direct
care
registered
14
nurse
staffing
plan
developed
pursuant
to
this
section.
15
c.
A
nursing
facility
or
mental
health
institute
shall
16
ensure
that
only
a
direct
care
registered
nurse
may
relieve
17
another
direct
care
registered
nurse
during
breaks,
meals,
and
18
other
routine,
expected
absences
from
a
nursing
facility
or
19
mental
health
institute
unit.
20
d.
A
nursing
facility
or
mental
health
institute
shall
not
21
encroach
on
the
scope
of
practice
of
a
direct
care
registered
22
nurse.
A
nursing
facility
or
mental
health
institute
shall
not
23
require
a
direct
care
registered
nurse
to
train
a
replacement
24
if
doing
so
would
compromise
patient
safety.
25
e.
A
nursing
facility
or
mental
health
institute
shall
26
establish
a
system
to
document
actual
staffing
in
each
unit
for
27
each
shift.
28
f.
To
the
extent
appropriate
based
on
the
staffing
plan
in
29
each
unit
in
relation
to
actual
patient
care
requirements
and
30
the
accuracy
of
the
acuity
system,
a
nursing
facility
or
mental
31
health
institute
shall
annually
approve
updates
to
the
nurse
32
staffing
plan
developed
by
the
collaborative
nurse
staffing
33
committee.
34
g.
Once
developed,
a
nursing
facility
or
mental
health
35
-6-
LSB
1228YH
(2)
85
ad/nh
6/
19
H.F.
31
institute
shall
conspicuously
post
the
required
staffing
levels
1
for
each
unit
in
the
unit
and
in
waiting
areas.
The
postings
2
must
be
visible
to
nursing
facility
or
mental
health
institute
3
staff,
patients,
and
the
public.
4
4.
A
nursing
facility
or
mental
health
institute
shall
5
not
discipline
a
direct
care
registered
nurse
for
refusing
6
to
accept
an
assignment
if,
in
good
faith
and
in
the
nurse’s
7
professional
judgment,
the
nurse
determines
that
the
assignment
8
is
unsafe
for
patients
due
to
patient
acuity
and
nursing
9
intensity.
10
5.
The
requirements
established
in
this
section
shall
not
11
apply
during
a
state
of
emergency
if
a
nursing
facility
or
12
mental
health
institute
is
requested
or
expected
to
provide
an
13
exceptional
level
of
emergency
or
other
medical
services.
14
6.
The
department
may
sanction
a
nursing
facility
for
15
failure
to
comply
with
the
provisions
of
this
section,
16
including
failure
to
staff
patient
care
units
at
levels
17
required
in
its
staffing
plan.
18
7.
The
department
may
adopt
rules
to
enforce
this
section.
19
Sec.
4.
NEW
SECTION
.
135P.4
Collaborative
nurse
staffing
20
committee.
21
1.
A
hospital,
nursing
facility,
or
mental
health
institute
22
shall
establish
a
collaborative
nurse
staffing
committee
23
comprised
of
nonsupervisory
staff
nurses.
The
membership
of
24
the
committee
shall
be
apportioned
among
registered
nurses,
25
licensed
practical
nurses,
and
advanced
practice
registered
26
nurses
based
upon
the
proportion
of
each
type
of
nonsupervisory
27
nurse
licensee
to
the
total
of
all
nonsupervisory
nurses
28
employed
by
the
hospital,
nursing
facility,
or
mental
health
29
institute.
Each
member
of
the
committee
shall
be
appointed
30
respectively
by
other
nonsupervisory
nurses
who
hold
the
same
31
license.
The
committee
shall
include
at
least
six
members,
and
32
shall
meet
at
least
annually.
The
hospital,
nursing
facility,
33
or
mental
health
institute
shall
compensate
the
nurses
who
34
are
employed
by
the
hospital,
nursing
facility,
or
mental
35
-7-
LSB
1228YH
(2)
85
ad/nh
7/
19
H.F.
31
health
institute
and
serve
on
the
collaborative
nurse
staffing
1
committee
for
time
spent
on
committee
business.
2
2.
By
majority
vote,
the
committee
may
establish
its
own
3
rules
and
procedures,
and
shall
set
the
term
of
membership.
4
3.
a.
The
committee
shall
recommend
a
nurse
staffing
plan
5
to
the
hospital,
nursing
facility,
or
mental
health
institute
6
as
provided
under
sections
135P.2
and
135P.3.
If
the
hospital,
7
nursing
facility,
or
mental
health
institute
does
not
approve
8
the
plan,
the
hospital,
nursing
facility,
or
mental
health
9
institute
shall
provide
a
written
response
to
the
committee,
10
indicating
the
reasons
for
not
approving
the
recommended
nurse
11
staffing
plan.
12
b.
The
committee
shall
annually
evaluate
its
staffing
13
plan
for
each
type
of
unit
in
relation
to
actual
patient
care
14
requirements
and
the
accuracy
of
its
acuity
system.
The
15
committee
shall
recommend
updates
to
the
nurse
staffing
plan
16
annually
based
on
the
evaluation.
If
the
hospital,
nursing
17
facility,
or
mental
health
institute
does
not
approve
the
18
updates,
the
hospital,
nursing
facility,
or
mental
health
19
institute
shall
provide
a
written
response
to
the
committee,
20
indicating
the
reasons
for
not
approving
the
recommended
21
updates
to
the
nurse
staffing
plan.
22
c.
The
committee
shall
recommend
a
reporting
system
23
for
a
nurse
staffing
violation
that
allows
a
person
with
24
knowledge
of
the
violation,
including
but
not
limited
to
25
health
care
practitioners,
hospital,
nursing
facility,
or
26
mental
health
institute
employees,
patients,
and
visitors,
27
to
make
a
report
of
the
violation
to
the
department.
If
the
28
committee
makes
a
recommendation
to
the
hospital,
nursing
29
facility,
or
mental
health
institute
and
the
hospital,
nursing
30
facility,
or
mental
health
institute
does
not
approve
the
31
committee’s
recommendation,
the
hospital,
nursing
facility,
32
or
mental
health
institute
shall
provide
a
written
response
33
to
the
committee
indicating
the
reasons
for
not
approving
the
34
recommendation.
35
-8-
LSB
1228YH
(2)
85
ad/nh
8/
19
H.F.
31
4.
The
committee
may
make
other
recommendations
related
1
to
providing
direct
care
to
patients.
If
the
committee
2
makes
a
recommendation
to
the
hospital,
nursing
facility,
or
3
mental
health
institute
and
the
hospital,
nursing
facility,
4
or
mental
health
institute
does
not
approve
the
committee’s
5
recommendation,
the
hospital,
nursing
facility,
or
mental
6
health
institute
shall
provide
a
written
response
to
the
7
committee,
indicating
the
reasons
for
not
approving
the
8
recommendation
of
the
committee.
9
Sec.
5.
NEW
SECTION
.
135P.5
School
nurse
staffing.
10
1.
A
school
district
shall
approve,
implement,
and
comply
11
with
a
school
nurse
staffing
plan
developed
by
the
school
12
nurses
in
the
district.
The
plan
shall
provide
for
the
13
adequate,
appropriate,
and
quality
delivery
of
health
care
14
services.
15
2.
In
developing
the
school
nurse
staffing
plan,
the
school
16
nurses
shall
consider
the
following
factors:
17
a.
The
number
of
enrolled
students
in
the
school
district.
18
b.
The
anticipated
need
for
direct
health
care
services
at
19
each
school
in
the
district.
20
c.
Staffing
levels
and
services
provided
by
licensed
21
vocational
or
practical
nurses,
licensed
psychiatric
22
technicians,
certified
nurse
assistants,
or
other
ancillary
23
staff
in
meeting
direct
student
health
care
needs
not
required
24
by
a
direct
care
registered
nurse.
25
d.
The
level
of
technology
available
that
affects
the
26
delivery
of
direct
student
health
care.
27
e.
Obstacles
to
efficiency
in
the
delivery
of
student
health
28
care
including
the
location
of
schools
in
the
district.
29
f.
Other
information
relevant
to
student
health
care.
30
3.
The
school
nurse
staffing
plan
shall
include
but
is
not
31
limited
to:
32
a.
The
delivery
of
services
that
must
be
administered
by
a
33
school
nurse.
34
b.
The
delivery
of
services
that
require
direct
supervision
35
-9-
LSB
1228YH
(2)
85
ad/nh
9/
19
H.F.
31
of
a
school
nurse.
1
c.
The
delivery
of
services
that
require
indirect
2
supervision
of
a
school
nurse.
3
4.
If
the
school
district
does
not
approve
the
school
4
nurse
staffing
plan,
it
shall
provide
a
written
response
to
5
the
school
nurses,
indicating
the
reason
for
not
following
the
6
recommended
school
nurse
staffing
plan.
7
5.
The
school
nurses
shall
annually
evaluate
the
nurse
8
staffing
plan
and
meet
with
the
school
board
of
the
school
9
district
for
which
the
nurses
are
employed
to
recommend
updates
10
to
the
school
nurse
staffing
plan.
If
the
school
district
does
11
not
approve
the
updates
it
shall
provide
a
written
response
to
12
the
school
nurses,
indicating
the
reason
for
not
following
the
13
recommended
updates
to
the
nurse
staffing
plan.
14
6.
The
requirements
established
in
this
section
shall
15
not
apply
during
a
state
of
emergency
if
a
school
district
16
is
requested
or
expected
to
provide
an
exceptional
level
of
17
emergency
or
other
medical
services.
18
7.
The
school
district
must
compensate
school
nurses
19
for
time
spent
on
developing
and
evaluating
the
school
nurse
20
staffing
plan.
21
8.
The
school
nurses
may
make
other
recommendations
related
22
to
providing
direct
care
to
students
in
the
school
district.
23
If
the
school
nurses
make
a
recommendation
to
the
school
24
district
and
the
school
district
does
not
follow
the
school
25
nurses’
recommendation,
it
shall
provide
a
written
response
to
26
the
school
nurses,
indicating
the
reason
for
not
following
the
27
recommendation.
28
Sec.
6.
NEW
SECTION
.
152.13
Scope
of
practice.
29
The
scope
of
practice
of
a
direct
care
registered
nurse
shall
30
not
be
encroached
by
any
person.
31
Sec.
7.
Section
256.11,
subsection
9B,
Code
2013,
is
amended
32
to
read
as
follows:
33
9B.
Beginning
July
1,
2007,
each
school
district
shall
have
34
a
school
nurse
to
provide
health
services
to
its
students.
35
-10-
LSB
1228YH
(2)
85
ad/nh
10/
19
H.F.
31
Each
Beginning
July
1,
2016,
each
school
district
shall
work
1
toward
the
goal
of
having
have
at
least
one
full-time
school
2
nurse
for
every
seven
six
hundred
fifty
students
when
more
than
3
two
hundred
students
are
enrolled
in
the
school
district.
Each
4
school
district
shall
approve,
implement,
and
comply
with
a
5
nurse
staffing
plan
pursuant
to
section
135P.5.
For
purposes
6
of
this
subsection
,
“school
nurse”
means
a
person
who
holds
7
an
endorsement
or
a
statement
of
professional
recognition
for
8
school
nurses
issued
by
the
board
of
educational
examiners
9
under
chapter
272
.
10
Sec.
8.
EFFECTIVE
DATE.
11
1.
Except
as
otherwise
provided
by
this
Act,
this
division
12
of
this
Act
takes
effect
July
1,
2014.
13
2.
The
minimum
direct
care
registered
nurse-to-patient
14
ratios
established
in
sections
135P.2
and
135P.3,
as
enacted
in
15
this
division
of
this
Act,
and
the
school
nurse
staffing
plan
16
established
in
section
135P.5,
as
enacted
in
this
division
of
17
this
Act,
shall
take
effect
not
later
than
July
1,
2015,
or
in
18
the
case
of
a
critical
access
hospital
as
defined
in
42
U.S.C.
19
§
1395i-4,
not
later
than
July
1,
2017.
20
DIVISION
II
21
PATIENT
SAFETY
PLAN
22
Sec.
9.
NEW
SECTION
.
135P.6
Patient
safety
plan.
23
1.
A
hospital,
nursing
facility,
or
mental
health
institute
24
shall
develop,
implement,
and
comply
with
a
patient
safety
25
plan
for
the
purpose
of
improving
the
health
and
safety
of
26
patients
and
reducing
preventable
patient
safety
events.
The
27
patient
safety
plan
shall
be
developed
by
the
hospital,
nursing
28
facility,
or
mental
health
institute
in
coordination
with
the
29
entity’s
health
care
professionals.
30
2.
The
patient
safety
plan
shall,
at
a
minimum,
provide
for
31
the
establishment
of
all
of
the
following:
32
a.
A
patient
safety
committee
or
a
committee
equivalent
in
33
composition
and
function.
The
committee
shall
be
comprised
of
34
various
health
care
professionals
employed
by
the
hospital,
35
-11-
LSB
1228YH
(2)
85
ad/nh
11/
19
H.F.
31
nursing
facility,
or
mental
health
institute,
at
least
half
1
of
whom
shall
be
direct
care
nurses.
A
hospital,
nursing
2
facility,
or
mental
health
institute
shall
compensate
the
3
health
care
professionals
who
are
employed
by
the
hospital,
4
nursing
facility,
or
mental
health
institute
and
serve
on
the
5
patient
safety
committee
or
equivalent
committee
for
time
spent
6
on
committee
business.
7
b.
The
committee
shall
do
all
of
the
following:
8
(1)
Review
and
approve
the
patient
safety
plan.
9
(2)
Receive
and
review
reports
of
patient
safety
events
as
10
defined
in
subsection
3.
11
(3)
Monitor
implementation
of
corrective
actions
for
12
patient
safety
events.
13
(4)
Make
recommendations
to
eliminate
future
patient
safety
14
events.
15
(5)
Review
and
revise
the
patient
safety
plan
at
least
16
annually
to
evaluate
and
update
the
plan
and
to
incorporate
17
advancements
in
patient
safety
practices.
18
c.
A
reporting
system
for
patient
safety
events
that
allows
19
a
person
with
knowledge
of
a
patient
safety
event,
including
20
but
not
limited
to
health
care
practitioners
and
hospital,
21
nursing
facility,
or
mental
health
institute
employees,
22
patients,
and
visitors,
to
make
a
report
of
a
patient
safety
23
event
to
the
hospital,
nursing
facility,
or
mental
health
24
institute.
A
reporting
system
shall
support
and
encourage
a
25
culture
of
safety
and
the
reporting
of
patient
safety
events.
26
d.
A
process
for
a
team
of
hospital,
nursing
facility,
or
27
mental
health
institute
staff
to
conduct
analyses,
including
28
but
not
limited
to
root
cause
analyses
of
patient
safety
29
events.
The
team
shall
be
composed
of
the
entity’s
various
30
categories
of
health
care
professionals
with
the
appropriate
31
competencies
to
conduct
the
required
analyses.
32
e.
A
process
for
providing
ongoing
patient
safety
training
33
for
hospital,
nursing
facility,
or
mental
health
institute
34
personnel
and
health
care
practitioners.
35
-12-
LSB
1228YH
(2)
85
ad/nh
12/
19
H.F.
31
3.
For
the
purposes
of
this
section,
patient
safety
events
1
shall
be
defined
by
the
patient
safety
plan
and
shall
include
2
but
are
not
limited
to
health-care-associated
infections,
3
as
defined
in
the
federal
centers
for
disease
control
and
4
prevention’s
national
healthcare
safety
network,
or
its
5
successor,
unless
the
department
accepts
the
recommendation
of
6
the
healthcare-associated
infection
advisory
committee,
or
its
7
successor,
that
are
determined
to
be
preventable.
8
Sec.
10.
EFFECTIVE
DATE.
9
1.
Except
as
otherwise
provided
by
this
Act,
this
division
10
of
this
Act
takes
effect
July
1,
2014.
11
2.
The
implementation
of
a
hospital,
nursing
facility,
12
or
mental
health
institute
patient
safety
plan
pursuant
to
13
section
135P.6,
as
enacted
in
this
division
of
this
Act,
shall
14
take
effect
not
later
than
July
1,
2015,
or,
in
the
case
of
a
15
critical
access
hospital
as
defined
in
42
U.S.C.
§
1395i-4,
not
16
later
than
July
1,
2017.
17
DIVISION
III
18
PATIENT
PROTECTION
19
Sec.
11.
NEW
SECTION
.
135P.7
Retaliation
prohibited
——
20
remedies.
21
1.
a.
A
hospital,
nursing
facility,
mental
heath
institute,
22
or
school
district
shall
not
take
retaliatory
action
against
a
23
nurse
as
a
reprisal
when
the
nurse
reports
an
action
or
event
24
to
the
hospital,
nursing
facility,
mental
heath
institute,
25
or
school
district
or
to
the
department
or
other
applicable
26
entity,
and
the
nurse
reasonably
believes,
based
on
the
nurse’s
27
professional
standards
of
care,
professional
code
of
ethics,
or
28
other
established
guidelines
for
direct
care
workers
including
29
but
not
limited
to
a
patient
safety
plan
or
a
nurse
staffing
30
plan,
that
the
action
or
event
the
nurse
has
observed
occurring
31
at
the
hospital,
nursing
facility,
mental
heath
institute,
or
32
school
district
is
a
material
violation
of
health
and
safety
33
laws
or
a
breach
of
public
safety
that
has
caused
serious
harm
34
to
or
creates
a
significant
probability
of
serious
harm
to
35
-13-
LSB
1228YH
(2)
85
ad/nh
13/
19
H.F.
31
patients
or
health
care
recipients.
1
b.
For
purposes
of
this
section,
“retaliatory
action”
2
includes
but
is
not
limited
to
an
action
by
a
hospital,
nursing
3
facility,
mental
health
institute,
or
school
district
to
4
discharge
a
nurse
or
to
take
or
fail
to
take
action
regarding
5
a
nurse’s
appointment
or
proposed
appointment
to,
take
or
6
fail
to
take
action
regarding
a
nurse’s
promotion
or
proposed
7
promotion
to,
or
fail
to
provide
an
advantage
in
a
position
in
8
employment.
9
c.
Paragraph
“a
”
does
not
apply
if
the
disclosure
of
the
10
information
is
prohibited
by
statute.
11
2.
Subsection
1
may
be
enforced
through
a
civil
action.
12
a.
A
person
who
violates
subsection
1
is
liable
to
an
13
aggrieved
nurse
for
affirmative
relief
including
reinstatement,
14
with
or
without
back
pay,
or
any
other
equitable
relief
the
15
court
deems
appropriate,
including
attorney
fees
and
costs.
16
b.
When
a
person
commits,
is
committing,
or
proposes
to
17
commit
an
act
in
violation
of
subsection
1,
an
injunction
may
18
be
granted
through
an
action
in
district
court
to
prohibit
the
19
person
from
continuing
such
acts.
The
action
for
injunctive
20
relief
may
be
brought
by
the
aggrieved
nurse.
21
EXPLANATION
22
This
bill
relates
to
patient
safety
through
nurse
staffing.
23
The
bill
creates
new
Code
chapter
135P
to
establish
nurse
24
staffing
plans,
collaborative
nurse
staffing
committees,
and
25
patient
safety
plans.
The
bill
also
prohibits
retaliatory
26
action
against
nurses.
27
Division
I
of
the
bill
relates
to
nurse
staffing
plans.
28
The
bill
requires
a
hospital
to
approve,
implement,
and
29
comply
with
a
nurse
staffing
plan
developed
by
the
hospital’s
30
collaborative
nurse
staffing
committee
required
by
the
bill.
31
The
nurse
staffing
plan
must
provide
for
adequate,
appropriate,
32
and
quality
delivery
of
services
to
patients.
The
bill
sets
33
required
registered
nurse
staffing
levels
that
the
staffing
34
plan
must
include.
The
bill
provides
that
the
department
of
35
-14-
LSB
1228YH
(2)
85
ad/nh
14/
19
H.F.
31
inspections
and
appeals
(DIA)
may
apply
the
minimum
direct
care
1
registered
nurse-to-patient
ratios
to
other
hospital
units
if
2
the
unit
provides
a
level
of
care
to
patients
whose
needs
are
3
similar
to
that
listed.
The
bill
also
provides
factors
for
the
4
collaborative
nurse
staffing
committee
to
consider
when
setting
5
nurse-to-patient
ratios
above
what
is
listed
in
the
bill.
The
6
bill
provides
that
the
nurse
staffing
plan
provisions
should
7
not
be
construed
as
a
prohibition
on
the
hospital’s
ability
to
8
set
standards
that
are
equivalent
to
or
higher
than
set
under
9
the
bill.
10
The
bill
specifies
a
hospital’s
obligations
regarding
a
11
staffing
plan.
The
bill
prohibits
a
hospital
from
averaging
12
the
number
of
patients
and
total
number
of
direct
care
13
registered
nurses
assigned
to
a
unit
during
any
one
shift
or
14
over
a
period
of
a
time
in
order
to
meet
the
requirements
of
15
the
nurse
staffing
plan.
A
hospital
cannot
impose
mandatory
16
overtime
requirements
to
meet
the
ratios
required.
Only
direct
17
care
registered
nurses
can
relieve
other
direct
care
registered
18
nurses.
A
hospital
cannot
encroach
on
a
direct
care
registered
19
nurse’s
scope
of
practice
or
require
a
direct
care
registered
20
nurse
to
train
a
replacement
if
doing
so
would
jeopardize
21
patient
safety.
A
hospital
must
establish
a
system
to
document
22
staffing
in
each
unit
for
each
shift.
A
hospital
shall
23
approve
updates
to
the
nurse
staffing
plan
as
is
appropriate
24
in
relation
to
patient
care
requirements
and
the
accuracy
of
25
the
acuity
system.
A
hospital
must
conspicuously
post
staffing
26
levels
for
each
unit
in
the
unit
and
in
waiting
areas.
A
27
hospital
may
not
discipline
a
direct
care
registered
nurse
for
28
refusing
to
accept
an
assignment,
if
the
nurse
believes
in
good
29
faith
and
within
the
nurse’s
judgment
that
the
assignment
is
30
unsafe
for
patients.
The
bill
provides
that
the
requirements
31
established
do
not
apply
during
a
state
of
emergency.
The
bill
32
provides
an
exception
from
the
staffing
requirements
and
the
33
hospital
obligations
for
critical
access
hospitals.
The
bill
34
also
provides
for
the
DIA
to
sanction
a
hospital
for
failing
35
-15-
LSB
1228YH
(2)
85
ad/nh
15/
19
H.F.
31
to
comply
with
the
bill
and
allows
the
DIA
to
enact
rules
to
1
enforce
the
bill.
2
The
bill
imposes
similar
requirements
on
nursing
facilities
3
and
mental
health
institutes,
providing
factors
the
facility’s
4
or
mental
health
institute’s
collaborative
nurse
staffing
5
committee
must
consider
when
developing
a
staffing
plan,
but
6
the
bill
does
not
require
specific
staffing
ratios
for
nursing
7
facilities
or
mental
health
institutes.
8
The
bill
provides
that
hospitals,
nursing
facilities,
9
and
mental
health
institutes
shall
establish
collaborative
10
nurse
staffing
committees
comprised
of
nonsupervisory
staff
11
nurses.
The
membership
of
a
committee
shall
be
apportioned
12
among
registered
nurses,
licensed
practical
nurses,
and
13
advanced
practice
registered
nurses
based
upon
the
proportion
14
of
each
type
of
nonsupervisory
nurse
licensees
to
the
total
15
of
nonsupervisory
nurses
employed
by
the
hospital,
facility,
16
or
institute.
The
members
of
the
committee
will
be
appointed
17
by
other
nonsupervisory
nurses
with
the
same
license.
The
18
committee
must
have
six
members
and
must
meet
at
least
19
annually.
The
hospital,
nursing
facility,
or
mental
health
20
institute
must
compensate
the
employed
nurses
for
time
spent
21
on
committee
business.
The
committee
may
establish
its
own
22
rules
and
procedures
by
majority
vote.
The
committee
shall
23
recommend
a
nurse
staffing
plan
to
the
hospital,
facility,
or
24
institute.
The
hospital,
facility,
or
institute
must
provide
25
a
written
response
indicating
the
reasons
for
not
approving
26
the
plan
if
it
does
not
approve
the
plan.
The
committee
must
27
annually
evaluate
the
staffing
plan
and
recommend
updates
to
28
the
hospital,
nursing
facility,
or
mental
health
institute
29
respectively.
If
the
hospital,
nursing
facility,
or
mental
30
health
institute
does
not
approve
the
updates,
it
shall
provide
31
a
written
response
indicating
the
reasons.
The
committee
32
must
also
recommend
a
reporting
system
for
a
nurse
staffing
33
violation
that
allows
a
person
with
knowledge
of
the
violation
34
to
make
a
report
to
the
DIA.
The
committee
may
make
other
35
-16-
LSB
1228YH
(2)
85
ad/nh
16/
19
H.F.
31
recommendations
related
to
providing
direct
care
to
patients
1
to
the
hospital,
nursing
facility,
or
mental
health
institute,
2
respectively.
If
the
hospital,
nursing
facility,
or
mental
3
health
institute
does
not
approve
the
recommendation,
it
shall
4
provide
written
notice
indicating
the
reason.
5
The
bill
also
requires
a
school
district
to
approve,
6
implement,
and
comply
with
a
school
nurse
staffing
plan
7
developed
by
the
district’s
school
nurses.
The
bill
requires
8
the
district’s
school
nurses
to
consider,
the
number
of
9
enrolled
students,
the
need
for
direct
health
care
services
at
10
each
school,
the
staffing
levels
and
services
provided
by
other
11
ancillary
staff,
the
technology
available
that
affects
delivery
12
of
care,
obstacles
to
efficiency
including
the
location
of
13
schools
in
the
district,
and
other
relevant
information.
The
14
school
nursing
staffing
plan
must
include
at
least
the
delivery
15
of
services
required
to
be
administered
by
a
school
nurse,
the
16
delivery
of
services
that
require
the
direct
supervision
of
the
17
school
nurse,
and
the
delivery
of
services
that
require
the
18
indirect
supervision
of
a
school
nurse.
The
bill
states
that
19
a
school
district
that
does
not
approve
a
nurse
staffing
plan
20
must
provide
a
written
response
indicating
the
reason
for
not
21
following
the
plan.
22
The
bill
also
requires
school
nurses
to
annually
evaluate
23
the
nurse
staffing
plan
and
meet
with
the
school
board
to
24
recommend
updates
to
the
plan.
The
school
nurses
also
may
make
25
other
recommendations
to
the
school
district.
If
the
school
26
district
does
not
approve
the
updates
or
other
recommendations,
27
it
must
provide
a
written
response
indicating
the
reason
for
28
not
adopting
the
recommended
updates.
29
The
bill
requires
a
school
district
to
compensate
a
school
30
nurse
for
time
spent
developing
and
evaluating
the
school
nurse
31
staffing
plan.
32
The
bill
also
amends
Code
section
256.11
regarding
the
33
school
nurse
requirements
for
a
school
district.
The
bill
34
requires
a
school
district
which
has
more
than
200
students
35
-17-
LSB
1228YH
(2)
85
ad/nh
17/
19
H.F.
31
enrolled
to
have
at
least
one
full-time
school
nurse
for
every
1
600
students
beginning
in
2016.
2
The
division
takes
effect
July
1,
2014.
The
direct
care
3
registered
nurse-to-patient
ratios
and
school
nurse
staffing
4
plans
take
effect
not
later
than
July
1,
2015,
or
July
1,
2017,
5
for
a
critical
access
hospital.
6
Division
II
of
the
bill
relates
to
patient
safety
plans.
7
The
bill
provides
that
a
hospital,
nursing
facility,
or
8
mental
health
institute
must
develop,
implement,
and
comply
9
with
a
patient
safety
plan.
The
patient
safety
plan
must
10
include
and
establish
a
patient
safety
committee
or
equivalent
11
committee.
The
committee
shall
be
comprised
of
the
entity’s
12
various
health
care
professionals,
but
at
least
half
of
the
13
committee
shall
be
comprised
of
direct
care
nurses.
The
14
health
care
professionals
employed
by
the
entity
who
serve
15
on
the
committee
must
be
compensated
for
the
time
spent
on
16
committee
business.
The
patient
safety
committee
must
review
17
and
approve
the
patient
safety
plan,
receive
and
review
reports
18
of
patient
safety
events,
monitor
implementation
of
corrective
19
actions,
make
recommendations
to
eliminate
future
patient
20
safety
events,
review
and
revise
the
patient
safety
plan
at
21
least
annually,
and
update
the
plan.
The
bill
provides
that
a
22
patient
safety
plan
must
include
a
reporting
system
for
patient
23
safety
events,
a
process
for
a
team
of
the
entity’s
staff
to
24
conduct
analyses
of
patient
safety
events,
and
a
process
for
25
providing
ongoing
patient
safety
training.
The
bill
states
26
that
a
“patient
safety
event”,
as
used
in
the
bill,
shall
be
27
defined
by
the
patient
safety
plan.
This
division
of
the
bill
28
related
to
patient
safety
plans
takes
effect
July
1,
2014.
29
The
implementation
of
a
patient
safety
plan
shall
take
effect
30
by
July
1,
2015,
except
that
a
critical
access
hospital
must
31
implement
a
patient
safety
plan
by
July
1,
2017.
32
Division
III
of
the
bill
relates
to
nurses
reporting
33
violations
that
affect
patient
safety.
The
bill
provides
34
that
a
hospital,
nursing
facility,
mental
health
institute,
35
-18-
LSB
1228YH
(2)
85
ad/nh
18/
19
H.F.
31
or
school
district
shall
not
discharge
or
otherwise
retaliate
1
against
a
nurse
employed
by
the
entity
as
a
reprisal
when
the
2
nurse
reports
an
action
or
event
to
the
entity,
DIA,
or
other
3
applicable
state
agency
and
the
nurse
reasonably
believes
the
4
action
or
event
is
a
material
violation
of
health
and
safety
5
laws
or
is
a
breach
of
public
safety
that
has
caused
serious
6
harm
to
or
creates
a
significant
probability
of
serious
harm
7
to
patients
or
health
care
recipients.
The
division
does
not
8
apply
if
the
disclosure
is
prohibited
by
statute.
A
person
9
who
violates
the
division
is
liable
to
an
aggrieved
nurse
for
10
affirmative
relief
including
reinstatement
with
or
without
back
11
pay
or
any
other
equitable
relief
the
court
deems
appropriate.
12
The
bill
also
provides
for
an
injunction
when
a
person
is
13
committing
or
proposes
to
commit
an
act
in
violation
of
the
14
division.
15
-19-
LSB
1228YH
(2)
85
ad/nh
19/
19