Bill Text: MN SF2182 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Registered nurse staffing levels development for patient safety requirements
Spectrum: Moderate Partisan Bill (Democrat 4-1)
Status: (Introduced - Dead) 2012-03-01 - Referred to Health and Human Services [SF2182 Detail]
Download: Minnesota-2011-SF2182-Introduced.html
1.2relating to health; requiring hospitals to develop staffing levels for direct care
1.3registered nurses;proposing coding for new law in Minnesota Statutes, chapter
1.4144.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [144.591] REGISTERED NURSE STAFFING FOR PATIENT SAFETY.
1.7 Subdivision 1. Definitions. (a) "Assignment" means the provision of care to a
1.8patient for whom a direct care registered nurse has responsibility within the nurse's scope
1.9of practice.
1.10(b) "Assignment limit" means the maximum number of patients for whom one
1.11direct care registered nurse can be responsible during a shift. Assignment limits may
1.12vary by nursing unit.
1.13(c) "Direct care registered nurse" means a registered nurse, as defined in section
1.14148.171, who is directly providing nursing care to patients.
1.15(d) "Nursing intensity" means a patient-specific, not diagnosis-specific, measurement
1.16of nursing care resources expended during a patient's hospitalization. A measurement of
1.17nursing intensity includes the complexity of care required for a patient and the knowledge
1.18and skill needed by a nurse for surveillance of patients in order to make continuous,
1.19appropriate clinical decisions in the care of patients.
1.20(e) "Patient acuity" means the measure of a patient's severity of illness or medical
1.21condition including, but not limited to, the stability of physiological and psychological
1.22parameters and the dependency needs of the patient and the patient's family. Higher
1.23patient acuity requires more intensive nursing time and advanced nursing skills for
1.24continuous surveillance.
2.1(f) "Skill mix" means the composition of nursing staff by licensure and education
2.2including but not limited to registered nurses, licensed practical nurses, and unlicensed
2.3personnel.
2.4(g) "Surveillance" means the continuous process of observing patients for early
2.5detection and intervention in an effort to prevent negative patient outcomes.
2.6(h) "Unit" means an area or location of a hospital where patients receive care based
2.7on similar patient acuity and nursing intensity.
2.8 Subd. 2. Staffing plan. (a) By July 1, 2013, all hospitals licensed under section
2.9144.55 shall adopt and implement a staffing plan that sets out the maximum number of
2.10patients that may be assigned to a direct care registered nurse for each unit of the hospital
2.11in order to ensure adequate staffing levels for patient safety. Staffing plans adopted and
2.12implemented under this section shall establish staffing levels that include the flexibility
2.13to increase the number of nurses required for a unit when necessary for patient safety.
2.14The staffing plans must be developed in agreement with direct care registered nurses
2.15and must comply with the requirements in subdivision 3. The staffing plans developed
2.16under this section must require that direct care registered nurses be assigned less patients
2.17than provided in subdivision 3 if the staffing for patient safety committee defined in
2.18subdivision 5 determines lower assignment limits are necessary for patient safety based on
2.19the following additional considerations:
2.20(1) results of the assessment performed by the staffing for patient safety committee,
2.21as required in subdivision 5, paragraph (c);
2.22(2) the number of patients in each unit, the acuity of patients, and the level and
2.23variation in the nursing intensity needed for patients;
2.24(3) anticipated admissions, discharges, and transfers of patients during each shift;
2.25(4) specialized experience or knowledge required of direct care registered nurses
2.26for a particular unit;
2.27(5) the skill mix of regularly scheduled direct care registered nurses, licensed
2.28practical nurses, and unlicensed personnel;
2.29(6) staffing levels, availability, and services provided by other health care personnel
2.30who provide direct patient care, including ancillary and temporary staff;
2.31(7) work environment factors that affect staffing needs and the delivery of care
2.32including, but not limited to, building architecture and layout, available technology, and
2.33staff familiarity with hospital practices and policies;
2.34(8) relevant national nursing and specialty organizations' standards for staffing; and
2.35(9) nursing-sensitive quality outcomes.
3.1(b) Staffing plans must include staffing levels as developed by the staffing for patient
3.2safety committee for specialty units including but not limited to procedural, observation,
3.3bariatric, interventional radiology, and electrophysiology units. Staffing for patient safety
3.4committees must use the considerations in paragraph (a), clauses (1) to (9), to develop
3.5staffing levels for specialty units.
3.6(c) In addition to the requirements in paragraph (a), hospital staffing plans must
3.7include the information gathered and developed according to subdivision 5, paragraph (c),
3.8clauses (1) to (4).
3.9(d) Compliance with staffing levels for direct care registered nurses does not permit
3.10a hospital to inadequately staff other health care workers including but not limited to
3.11licensed practical nurses, unlicensed personnel, respiratory therapists, occupational
3.12therapists, physical therapists, and health unit coordinators.
3.13(e) By July 1, 2013, every hospital licensed in the state must submit its staffing
3.14plan to the commissioner.
3.15 Subd. 3. Assignment limits for direct care registered nurses. (a) Staffing plans
3.16developed under subdivision 2 may not permit direct care registered nurses to be assigned
3.17more patients than the following for any shift:
3.18(1) one registered nurse to one patient in: (i) operating rooms; (ii) trauma units; (iii)
3.19for patients in the second and third stages of labor; and (iv) for unstable patients requiring
3.20transfer to another unit;
3.21(2) one registered nurse to two patients: (i) in postanesthesia care units; (ii) in critical
3.22care units; and (iii) for patients in the first stage of labor;
3.23(3) one registered nurse to three patients in: (i) intermediate care newborn nurseries;
3.24(ii) telemetry units; and (iii) emergency departments;
3.25(4) one registered nurse to four patients: (i) in medical and surgical units; (ii) in
3.26pediatric units; and (iii) for noncritical antepartum patients;
3.27(5) one registered nurse to five patients in: (i) rehabilitation care units; (ii) acute
3.28psychiatric mental health units; and (iii) chemical dependency units; and
3.29(6) one registered nurse to six patients, or three couplets, in uncomplicated
3.30postpartum or routine well-baby units.
3.31(b) The registered nurse staffing levels represent the maximum number of patients to
3.32which a direct care registered nurse may be assigned at all points during a shift and is not
3.33an average number of patients to a total number of nurses on a unit during a shift.
3.34(c) Nothing in this section requires a hospital with lower patient assignment limits
3.35than those in clauses (1) to (6) to increase its assignment limits.
4.1(d) Nothing in this section limits the rights of organized nurses to bargain on the
4.2issue of assignment limits.
4.3 Subd. 4. Assignment adjustments. (a) Hospitals must assign nursing personnel
4.4to each patient care unit according to its staffing plan. If a direct care registered nurse
4.5determines, based on the nurse's professional judgment, that adjustments in staffing levels
4.6are required due to patient acuity and nursing intensity, then shift-to-shift adjustments in
4.7staffing levels must be made according to the procedures developed by the staffing for
4.8patient safety committee.
4.9(b) A direct care registered nurse may not be disciplined for refusing to accept an
4.10assignment if, in good faith and in the nurse's professional judgment, the nurse determines
4.11that the assignment is unsafe for patients due to patient acuity and nursing intensity.
4.12 Subd. 5. RN Staffing for Patient Safety Committee. (a) By July 1, 2012, every
4.13hospital licensed in the state must establish an RN Staffing for Patient Safety Committee
4.14either by creating a new committee or assigning the functions of a staffing for patient
4.15safety committee to an existing committee.
4.16(b) Membership of the committee must include, but is not limited to, the following
4.17members:
4.18(1) at least one-half of the membership must be registered nurses who provide
4.19direct patient care; and
4.20(2) union-appointed members to proportionately represent its nurses.
4.21Hospitals must compensate registered nurses who are employed by the hospital and
4.22serve on the staffing for patient safety committee for time spent on committee business.
4.23(c) Staffing for patient safety committees shall:
4.24(1) complete a staffing for patient safety assessment by December 1, 2012, that
4.25identifies the following:
4.26(i) problems of insufficient staffing including but not limited to inappropriate number
4.27of registered nurses scheduled in a unit, inappropriately experienced registered nurses
4.28scheduled for a particular unit, inability for nurse supervisors to adjust for increased acuity
4.29or activity in a unit, and chronically unfilled positions within the hospital;
4.30(ii) units that pose the highest risk to patient safety due to inadequate staffing; and
4.31(iii) solutions for problems identified under items (i) and (ii);
4.32(2) develop staffing levels for each unit of the hospital that meet the requirements
4.33in subdivisions 2 and 3;
4.34(3) recommend a mechanism for tracking and analyzing staffing trends within the
4.35hospital;
5.1(4) develop a procedure for making shift-to-shift adjustments in staffing levels when
5.2such adjustments are required by patient acuity and nursing intensity; and
5.3(5) conduct evaluations, at least semiannually, of staffing plans and progress toward
5.4goals established in the policy and submit any changes made to staffing levels to the
5.5commissioner.
5.6 Subd. 6. Posting staffing levels. Once developed, the staffing levels for each unit
5.7must be conspicuously posted in each unit and in waiting areas. The postings must be
5.8visible to hospital staff, patients, and the public.
5.9 Subd. 7. Enforcement. (a) If a hospital fails to develop and submit its staffing
5.10plan to the commissioner, the commissioner may suspend, revoke, fail to renew, or place
5.11conditions on the hospital's license to operate.
5.12(b) The commissioner may sanction a hospital for failure to comply with the
5.13provisions of this section, including failure to staff patient care units at levels required
5.14in its staffing plan.
5.15 Sec. 2. NURSING AND QUALITY PATIENT OUTCOMES STUDY.
5.16The commissioner of health, in consultation with hospitals, the Minnesota Board
5.17of Nursing, and the Minnesota Nurses Association, shall study how nursing care should
5.18be identified and reimbursed in hospital cost reports to more adequately reflect nurses'
5.19contributions to quality patient outcomes.
1.3registered nurses;proposing coding for new law in Minnesota Statutes, chapter
1.4144.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [144.591] REGISTERED NURSE STAFFING FOR PATIENT SAFETY.
1.7 Subdivision 1. Definitions. (a) "Assignment" means the provision of care to a
1.8patient for whom a direct care registered nurse has responsibility within the nurse's scope
1.9of practice.
1.10(b) "Assignment limit" means the maximum number of patients for whom one
1.11direct care registered nurse can be responsible during a shift. Assignment limits may
1.12vary by nursing unit.
1.13(c) "Direct care registered nurse" means a registered nurse, as defined in section
1.14148.171, who is directly providing nursing care to patients.
1.15(d) "Nursing intensity" means a patient-specific, not diagnosis-specific, measurement
1.16of nursing care resources expended during a patient's hospitalization. A measurement of
1.17nursing intensity includes the complexity of care required for a patient and the knowledge
1.18and skill needed by a nurse for surveillance of patients in order to make continuous,
1.19appropriate clinical decisions in the care of patients.
1.20(e) "Patient acuity" means the measure of a patient's severity of illness or medical
1.21condition including, but not limited to, the stability of physiological and psychological
1.22parameters and the dependency needs of the patient and the patient's family. Higher
1.23patient acuity requires more intensive nursing time and advanced nursing skills for
1.24continuous surveillance.
2.1(f) "Skill mix" means the composition of nursing staff by licensure and education
2.2including but not limited to registered nurses, licensed practical nurses, and unlicensed
2.3personnel.
2.4(g) "Surveillance" means the continuous process of observing patients for early
2.5detection and intervention in an effort to prevent negative patient outcomes.
2.6(h) "Unit" means an area or location of a hospital where patients receive care based
2.7on similar patient acuity and nursing intensity.
2.8 Subd. 2. Staffing plan. (a) By July 1, 2013, all hospitals licensed under section
2.9144.55 shall adopt and implement a staffing plan that sets out the maximum number of
2.10patients that may be assigned to a direct care registered nurse for each unit of the hospital
2.11in order to ensure adequate staffing levels for patient safety. Staffing plans adopted and
2.12implemented under this section shall establish staffing levels that include the flexibility
2.13to increase the number of nurses required for a unit when necessary for patient safety.
2.14The staffing plans must be developed in agreement with direct care registered nurses
2.15and must comply with the requirements in subdivision 3. The staffing plans developed
2.16under this section must require that direct care registered nurses be assigned less patients
2.17than provided in subdivision 3 if the staffing for patient safety committee defined in
2.18subdivision 5 determines lower assignment limits are necessary for patient safety based on
2.19the following additional considerations:
2.20(1) results of the assessment performed by the staffing for patient safety committee,
2.21as required in subdivision 5, paragraph (c);
2.22(2) the number of patients in each unit, the acuity of patients, and the level and
2.23variation in the nursing intensity needed for patients;
2.24(3) anticipated admissions, discharges, and transfers of patients during each shift;
2.25(4) specialized experience or knowledge required of direct care registered nurses
2.26for a particular unit;
2.27(5) the skill mix of regularly scheduled direct care registered nurses, licensed
2.28practical nurses, and unlicensed personnel;
2.29(6) staffing levels, availability, and services provided by other health care personnel
2.30who provide direct patient care, including ancillary and temporary staff;
2.31(7) work environment factors that affect staffing needs and the delivery of care
2.32including, but not limited to, building architecture and layout, available technology, and
2.33staff familiarity with hospital practices and policies;
2.34(8) relevant national nursing and specialty organizations' standards for staffing; and
2.35(9) nursing-sensitive quality outcomes.
3.1(b) Staffing plans must include staffing levels as developed by the staffing for patient
3.2safety committee for specialty units including but not limited to procedural, observation,
3.3bariatric, interventional radiology, and electrophysiology units. Staffing for patient safety
3.4committees must use the considerations in paragraph (a), clauses (1) to (9), to develop
3.5staffing levels for specialty units.
3.6(c) In addition to the requirements in paragraph (a), hospital staffing plans must
3.7include the information gathered and developed according to subdivision 5, paragraph (c),
3.8clauses (1) to (4).
3.9(d) Compliance with staffing levels for direct care registered nurses does not permit
3.10a hospital to inadequately staff other health care workers including but not limited to
3.11licensed practical nurses, unlicensed personnel, respiratory therapists, occupational
3.12therapists, physical therapists, and health unit coordinators.
3.13(e) By July 1, 2013, every hospital licensed in the state must submit its staffing
3.14plan to the commissioner.
3.15 Subd. 3. Assignment limits for direct care registered nurses. (a) Staffing plans
3.16developed under subdivision 2 may not permit direct care registered nurses to be assigned
3.17more patients than the following for any shift:
3.18(1) one registered nurse to one patient in: (i) operating rooms; (ii) trauma units; (iii)
3.19for patients in the second and third stages of labor; and (iv) for unstable patients requiring
3.20transfer to another unit;
3.21(2) one registered nurse to two patients: (i) in postanesthesia care units; (ii) in critical
3.22care units; and (iii) for patients in the first stage of labor;
3.23(3) one registered nurse to three patients in: (i) intermediate care newborn nurseries;
3.24(ii) telemetry units; and (iii) emergency departments;
3.25(4) one registered nurse to four patients: (i) in medical and surgical units; (ii) in
3.26pediatric units; and (iii) for noncritical antepartum patients;
3.27(5) one registered nurse to five patients in: (i) rehabilitation care units; (ii) acute
3.28psychiatric mental health units; and (iii) chemical dependency units; and
3.29(6) one registered nurse to six patients, or three couplets, in uncomplicated
3.30postpartum or routine well-baby units.
3.31(b) The registered nurse staffing levels represent the maximum number of patients to
3.32which a direct care registered nurse may be assigned at all points during a shift and is not
3.33an average number of patients to a total number of nurses on a unit during a shift.
3.34(c) Nothing in this section requires a hospital with lower patient assignment limits
3.35than those in clauses (1) to (6) to increase its assignment limits.
4.1(d) Nothing in this section limits the rights of organized nurses to bargain on the
4.2issue of assignment limits.
4.3 Subd. 4. Assignment adjustments. (a) Hospitals must assign nursing personnel
4.4to each patient care unit according to its staffing plan. If a direct care registered nurse
4.5determines, based on the nurse's professional judgment, that adjustments in staffing levels
4.6are required due to patient acuity and nursing intensity, then shift-to-shift adjustments in
4.7staffing levels must be made according to the procedures developed by the staffing for
4.8patient safety committee.
4.9(b) A direct care registered nurse may not be disciplined for refusing to accept an
4.10assignment if, in good faith and in the nurse's professional judgment, the nurse determines
4.11that the assignment is unsafe for patients due to patient acuity and nursing intensity.
4.12 Subd. 5. RN Staffing for Patient Safety Committee. (a) By July 1, 2012, every
4.13hospital licensed in the state must establish an RN Staffing for Patient Safety Committee
4.14either by creating a new committee or assigning the functions of a staffing for patient
4.15safety committee to an existing committee.
4.16(b) Membership of the committee must include, but is not limited to, the following
4.17members:
4.18(1) at least one-half of the membership must be registered nurses who provide
4.19direct patient care; and
4.20(2) union-appointed members to proportionately represent its nurses.
4.21Hospitals must compensate registered nurses who are employed by the hospital and
4.22serve on the staffing for patient safety committee for time spent on committee business.
4.23(c) Staffing for patient safety committees shall:
4.24(1) complete a staffing for patient safety assessment by December 1, 2012, that
4.25identifies the following:
4.26(i) problems of insufficient staffing including but not limited to inappropriate number
4.27of registered nurses scheduled in a unit, inappropriately experienced registered nurses
4.28scheduled for a particular unit, inability for nurse supervisors to adjust for increased acuity
4.29or activity in a unit, and chronically unfilled positions within the hospital;
4.30(ii) units that pose the highest risk to patient safety due to inadequate staffing; and
4.31(iii) solutions for problems identified under items (i) and (ii);
4.32(2) develop staffing levels for each unit of the hospital that meet the requirements
4.33in subdivisions 2 and 3;
4.34(3) recommend a mechanism for tracking and analyzing staffing trends within the
4.35hospital;
5.1(4) develop a procedure for making shift-to-shift adjustments in staffing levels when
5.2such adjustments are required by patient acuity and nursing intensity; and
5.3(5) conduct evaluations, at least semiannually, of staffing plans and progress toward
5.4goals established in the policy and submit any changes made to staffing levels to the
5.5commissioner.
5.6 Subd. 6. Posting staffing levels. Once developed, the staffing levels for each unit
5.7must be conspicuously posted in each unit and in waiting areas. The postings must be
5.8visible to hospital staff, patients, and the public.
5.9 Subd. 7. Enforcement. (a) If a hospital fails to develop and submit its staffing
5.10plan to the commissioner, the commissioner may suspend, revoke, fail to renew, or place
5.11conditions on the hospital's license to operate.
5.12(b) The commissioner may sanction a hospital for failure to comply with the
5.13provisions of this section, including failure to staff patient care units at levels required
5.14in its staffing plan.
5.15 Sec. 2. NURSING AND QUALITY PATIENT OUTCOMES STUDY.
5.16The commissioner of health, in consultation with hospitals, the Minnesota Board
5.17of Nursing, and the Minnesota Nurses Association, shall study how nursing care should
5.18be identified and reimbursed in hospital cost reports to more adequately reflect nurses'
5.19contributions to quality patient outcomes.
