Bill Text: NY A00108 | 2021-2022 | General Assembly | Amended
Bill Title: Enacts the "safe staffing for quality care act" to require acute care facilities and nursing homes to implement certain direct-care nurse to patient ratios in all nursing units; sets minimum staffing requirements; requires every such facility to submit a documented staffing plan to the department on an annual basis and upon application for an operating certificate; requires acute care facilities to maintain staffing records during all shifts; authorizes nurses to refuse work assignments if the assignment exceeds the nurse's abilities or if minimum staffing is not present; requires public access to documented staffing plans; imposes civil penalties for violations of such provisions; establishes private right of action for nurses discriminated against for refusing any illegal work assignment.
Spectrum: Moderate Partisan Bill (Democrat 92-12)
Status: (Introduced) 2021-02-17 - print number 108a [A00108 Detail]
Download: New_York-2021-A00108-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 108--A 2021-2022 Regular Sessions IN ASSEMBLY (Prefiled) January 6, 2021 ___________ Introduced by M. of A. GUNTHER, GOTTFRIED, PEOPLES-STOKES, BARRETT, L. ROSENTHAL, BRONSON, COLTON, BENEDETTO, CRUZ, MAGNARELLI, WEPRIN, J. RIVERA, FALL, AUBRY, OTIS, STECK, SANTABARBARA, ZEBROWSKI, ABINAN- TI, BARRON, SEAWRIGHT, WALKER, BICHOTTE HERMELYN, RICHARDSON, HYNDMAN, PICHARDO, JOYNER, JEAN-PIERRE, ROZIC, KIM, HEVESI, O'DONNELL, DILAN, DAVILA, HUNTER, WILLIAMS, CARROLL, WOERNER, PHEFFER AMATO, JONES, VANEL, NIOU, TAYLOR, DINOWITZ, DICKENS, WALLACE, REYES, STERN, SAYEGH, JACOBSON, McMAHON, ABBATE, CAHILL, FERNANDEZ, FRONTUS, EPSTEIN, BUTTENSCHON, RAMOS, DARLING, BRAUNSTEIN, DE LA ROSA, GRIFFIN, QUART, McDONALD, ENGLEBRIGHT, GALLAGHER, BURKE, KELLES, CYMBROWITZ, CLARK, MEEKS, BRABENEC, SMITH, MONTESANO, SALKA, SCHMITT, MORINELLO, B. MILL- ER, ASHBY, M. MILLER, DeSTEFANO, FORREST, GONZALEZ-ROJAS, BURDICK -- Multi-Sponsored by -- M. of A. BARNWELL, COOK, CUSICK, FAHY, GALEF, GLICK, LUPARDO, McDONOUGH, MIKULIN, PAULIN, PERRY, PRETLOW, RA, D. ROSENTHAL, SIMON, SOLAGES, THIELE -- read once and referred to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to enacting the "safe staffing for quality care act" The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Short title. This act shall be known and may be cited as 2 the "safe staffing for quality care act". 3 § 2. Paragraphs (a) and (b) of subdivision 2 of section 2805 of the 4 public health law, paragraph (a) as amended by chapter 923 of the laws 5 of 1973 and paragraph (b) as added by chapter 795 of the laws of 1965, 6 are amended to read as follows: 7 (a) Application for an operating certificate for a hospital shall be 8 made upon forms prescribed by the department. The application shall 9 [contain] include the name of the hospital, the kind or kinds of hospi- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD02466-07-1A. 108--A 2 1 tal service to be provided, the location and physical description of the 2 institution, a documented staffing plan, as defined in section twenty- 3 eight hundred twenty-nine of this article, and such other information as 4 the department may require. 5 (b) An operating certificate shall not be issued by the department 6 unless it finds that the premises, equipment, personnel, documented 7 staffing plan, rules and by-laws, standards of medical care, and hospi- 8 tal service are fit and adequate and that the hospital will be operated 9 in the manner required by this article and rules and regulations there- 10 under. 11 § 3. The public health law is amended by adding nine new sections 12 2828, 2829, 2830, 2831, 2832, 2833, 2834, 2835 and 2836 to read as 13 follows: 14 § 2828. Policy and purpose. The legislature finds and declares all of 15 the following: 16 1. Health care services are becoming complex and it is increasingly 17 difficult for patients to access integrated services; 18 2. The quality of patient care is jeopardized because of nurse staff- 19 ing shortages and improper utilization of nursing services; 20 3. To ensure the adequate protection of patients in health care 21 settings, it is essential that qualified registered nurses and other 22 licensed nurses be accessible and available to meet the needs of 23 patients; and 24 4. The basic principles of staffing in the health care setting should 25 be based on the patient's care needs, the severity of condition, 26 services needed and the complexity surrounding those services. 27 § 2829. Safe staffing; definitions. The following words and phrases, 28 as used in this article, shall have the following meanings unless the 29 context otherwise plainly requires: 30 1. "Hospital" shall mean a general hospital under this article and 31 shall also include any facility that provides health care services 32 pursuant to the mental hygiene law, article nineteen-G of the executive 33 law or the correction law if such facility is operated by the state or a 34 political subdivision of the state or a public authority or public bene- 35 fit corporation. 36 2. "Acuity system" shall mean an established measurement instrument 37 which (a) predicts nursing care requirements for individual patients 38 based on severity of patient illness, need for specialized equipment and 39 technology, intensity of nursing interventions required, and the 40 complexity of clinical nursing judgment needed to design, implement and 41 evaluate the patient's nursing care plan; (b) details the amount of 42 nursing care needed, both in number of direct-care nurses and in skill 43 mix of nursing personnel required, on a daily basis, for each patient in 44 a nursing department or unit; and (c) is stated in terms that readily 45 can be used and understood by direct-care nurses. The acuity system 46 shall take into consideration the patient care services provided not 47 only by registered professional nurses but also by licensed practical 48 nurses, social workers and other health care personnel. 49 3. "Assessment tool" shall mean a measurement system that compares the 50 staffing level in each nursing department or unit against actual patient 51 nursing care requirements in order to review the accuracy of an acuity 52 system. 53 4. "Direct-care nurse" and "direct-care nursing staff" shall mean any 54 nurse who has principal responsibility to oversee or carry out medical 55 regimens, nursing or other bedside care for one or more patients.A. 108--A 3 1 5. "Documented staffing plan" shall mean a detailed written plan 2 setting forth the minimum number and classification of direct-care nurs- 3 es required in each nursing department or unit in a hospital for a given 4 year, based on reasonable projections derived from the patient census 5 and average acuity level within each department or unit during the prior 6 year, the department or unit size and geography, the nature of services 7 provided and any foreseeable changes in department or unit size or func- 8 tion during the current year. 9 6. "Nurse" shall mean a registered professional nurse or licensed 10 practical nurse licensed pursuant to article one hundred thirty-nine of 11 the education law. 12 7. "Nursing care" shall mean that care which is within the definition 13 of the practice of nursing pursuant to section sixty-nine hundred two of 14 the education law, or otherwise encompassed with the recognized stand- 15 ards of nursing practice, including assessment, nursing diagnosis, plan- 16 ning, intervention, evaluation and patient advocacy. 17 8. "Safe staffing requirements" shall mean the provisions of this 18 section and sections twenty-eight hundred twenty-nine, twenty-eight 19 hundred thirty, twenty-eight hundred thirty-one, twenty-eight hundred 20 thirty-two, twenty-eight hundred thirty-three, twenty-eight hundred 21 thirty-four, twenty-eight hundred thirty-five and twenty-eight hundred 22 thirty-six of this article and all rules and regulations adopted pursu- 23 ant thereto. 24 9. "Skill mix" shall mean the differences in licensing, specialty and 25 experience among direct-care nurses. 26 10. "Staffing level" shall mean the actual numerical nurse to patient 27 ratio within a nursing department or unit. 28 11. "Unit" shall mean a patient care component, as defined by the 29 department, within a hospital. 30 12. "Non-nursing direct-care staff" shall mean any employee who is not 31 a nurse or other person licensed, certified or registered under title 32 eight of the education law whose principal responsibility is to carry 33 out patient care for one or more patients or provides direct assistance 34 in the delivery of patient care. 35 § 2830. Commissioner and council; powers and duties. The commissioner 36 shall: 37 1. appoint a hospital council consisting of thirteen members. No less 38 than seven members shall be registered professional nurses, three of 39 whom shall be direct care registered nurses, three of whom shall be 40 nurse managers and one of whom shall be a nurse administrator. No less 41 than two members of the hospital council shall be representatives of 42 recognized or certified collective bargaining agents of non-nursing 43 direct care staff. There shall be at least two representatives of hospi- 44 tals, one representative of a nursing professional association, and one 45 representative of a recognized or certified bargaining agent of nurses. 46 The hospital council shall advise the commissioner in the development of 47 regulations, including registered professional nurse to patient staffing 48 requirements and non-nursing direct-care staff to patient ratios that 49 are not specified in this article; the efficacy of acuity systems 50 submitted for approval by the commissioner; the development of an 51 assessment tool used to evaluate the efficacy of acuity systems; and 52 review and make recommendations on approval of staffing plans prior to 53 the granting of an operating certificate by the department. 54 2. promulgate, after consultation with the hospital council, the rules 55 and regulations necessary to carry out the purposes and provisions of 56 the safe staffing requirements, including regulations defining terms,A. 108--A 4 1 setting forth direct-care nurse to patient ratios, setting forth non- 2 nursing direct-care staff to patient ratios and prescribing the process 3 for approving facility specific acuity systems; and 4 3. assure that the provisions of safe staffing requirements are 5 enforced, including the issuance of regulations which at a minimum 6 provide for an accessible and confidential system to report the failure 7 to comply with such requirements and public access to information 8 regarding reports of inspections, results, deficiencies and corrections 9 pursuant to such requirements. 10 § 2831. Staffing requirements. 1. Staffing requirements. Each hospital 11 shall ensure that it is staffed in a manner that provides sufficient, 12 appropriately qualified direct-care nurses in each department or unit 13 within such facility in order to meet the individualized care needs of 14 the patients therein. At a minimum, each such facility shall meet the 15 requirements of subdivisions two and three of this section. 16 2. Staffing plan. The department shall not issue an operating certif- 17 icate to any hospital unless such facility annually submits to the 18 department a documented staffing plan and a written certification that 19 the submitted staffing plan is sufficient to provide adequate and appro- 20 priate delivery of health care services to patients for the ensuing 21 year. The documented staffing plan shall: 22 (a) meet the minimum requirements set forth in subdivision three of 23 this section; 24 (b) be adequate to meet any additional requirements provided by other 25 laws, rules or regulations; 26 (c) employ and identify an acuity system for addressing fluctuations 27 in actual patient acuity levels and nursing care requirements requiring 28 increased staffing levels above the minimums set forth in the plan; 29 (d) factor in other unit or department activity such as discharges, 30 transfers and admissions, staff breaks, meals, routine and expected 31 absences from the unit and administrative and support tasks that are 32 expected to be done by direct-care nurses in addition to direct nursing 33 care; 34 (e) include a plan to meet necessary staffing levels and services 35 provided by non-nursing direct-care staff in meeting patient care needs 36 pursuant to subdivision one of this section; provided, however, that the 37 staffing plan shall not incorporate or assume that nursing care func- 38 tions required by laws, rules or regulations, or accepted standards of 39 practice to be performed by a registered professional nurse are to be 40 performed by other personnel; 41 (f) identify the system that will be used to document actual staffing 42 on a daily basis within each department or unit; 43 (g) include a written assessment of the accuracy of the prior year's 44 staffing plan in light of actual staffing needs; 45 (h) identify each nurse staff classification referenced in such plan 46 together with a statement setting forth minimum qualifications for each 47 such classification; and 48 (i) be developed in consultation with a majority of the direct-care 49 nurses within each department or unit or, where such nurses are repres- 50 ented, with the applicable recognized or certified collective bargaining 51 representative or representatives of the direct-care nurses and of other 52 supportive and assistive staff. 53 3. Minimum staffing requirements. (a) The documented staffing plan 54 shall incorporate, at a minimum, the following direct-care nurse-to-pa- 55 tient ratios:A. 108--A 5 1 (i) one nurse to one patient: operating room and trauma emergency 2 units and maternal/child care units for the second or third stage of 3 labor; 4 (ii) one nurse to two patients: maternal/child care units for the 5 first stage of labor, and all critical care areas including emergency 6 critical care and all intensive care units and postanesthesia units; 7 (iii) one nurse to three patients: antepartum, emergency room, pedia- 8 trics, step-down and telemetry units and units for newborns and interme- 9 diate care nursery units; 10 (iv) one nurse to three patients: postpartum mother/baby couplets 11 (maximum six patients per nurse); 12 (v) one nurse to four patients: non-critical antepartum patients, 13 postpartum mother only units and medical/surgical and acute care psychi- 14 atric units; 15 (vi) one nurse to five patients: rehabilitation units and subacute 16 patients; and 17 (vii) one nurse to six patients: well-baby nursery units. 18 For any units not listed in this paragraph, including, but not limited 19 to, psychiatric units, and hospitals operated pursuant to the mental 20 hygiene law or the correction law, the department shall establish by 21 regulation the appropriate direct-care nurse-to-patient ratio. 22 (b) The nurse-to-patient ratios set forth in paragraph (a) of this 23 subdivision shall reflect the maximum number of patients that may be 24 assigned to each direct-care nurse in a unit at any one time. 25 (c) There shall be no averaging of the number of patients and the 26 total number of nurses on the unit during any one shift nor over any 27 period of time. 28 (d) The commissioner, in consultation with the hospital council, shall 29 establish regulations providing for the maintenance of minimum nurse-to- 30 patient ratios, as set forth in this section, including during routine 31 or expected absences from the unit, such as meals or breaks. 32 4. Licensed practical nurses. In any situation in which licensed prac- 33 tical nurses are included in the documented staffing plan, any patients 34 assigned to the licensed practical nurse shall also be included in 35 calculating the number of patients assigned to any registered profes- 36 sional nurse who is required by law, rule, regulation, contract or prac- 37 tice to supervise or oversee the direct-nursing care provided by the 38 licensed practical nurse. 39 5. Skill mix. The skill mix shall not incorporate or assume that nurs- 40 ing care functions required by section sixty-nine hundred two of the 41 education law or accepted standards of practice to be performed by a 42 registered professional nurse are to be performed by a licensed practi- 43 cal nurse or unlicensed assistive personnel, or that nursing care func- 44 tions required by section sixty-nine hundred two of the education law or 45 accepted standards of practice to be performed by a licensed practical 46 nurse are to be performed by unlicensed assistive personnel. 47 6. Adjustments by facility. The minimum staffing requirement and 48 nurse-to-patient ratio set forth in this section shall be adjusted by 49 the hospital as necessary to reflect the need for additional direct-care 50 nurses. Additional staff shall be assigned in accordance with the 51 approved, facility-specific patient acuity system for determining nurs- 52 ing care requirements, including the severity of the illness, the need 53 for specialized equipment and technology, the complexity of clinical 54 judgment needed to design, implement and evaluate the patient care plan 55 and the ability for self-care, and the licensure of the personnel 56 required for care.A. 108--A 6 1 7. Commissioner regulations. The commissioner may by regulation 2 require a documented staffing plan to have higher nurse-to-patient 3 ratios than those set forth in this section. 4 8. Nothing contained in this section shall supersede or diminish the 5 terms of a collective bargaining agreement that provides for staffing 6 ratios that exceed the ratios established under this section. 7 § 2832. Compliance with staffing plan and recordkeeping. 1. Each 8 hospital shall at all times staff in accordance with its documented 9 staffing plan and the staffing standards set forth in section twenty- 10 eight hundred thirty-one of this article; provided, however, that noth- 11 ing in this section shall be deemed to preclude any such facility from 12 implementing higher direct-care nurse-to-patient staffing levels, nor 13 shall the requirements set forth in such section twenty-eight hundred 14 thirty-one of this article be deemed to supersede or replace any higher 15 requirements otherwise mandated by law, regulation or contract. 16 2. For purposes of compliance with the minimum staffing requirements 17 standards set forth in section twenty-eight hundred thirty-one of this 18 article, no nurse shall be assigned, or included in the nurse-to-patient 19 ratio count in a nursing unit or a clinical area within a hospital 20 unless that nurse has an appropriate license pursuant to article one 21 hundred thirty-nine of the education law, has received prior orientation 22 in that clinical area sufficient to provide competent nursing care to 23 the patients in that unit or clinical area, and has demonstrated current 24 competence in providing care in that unit or clinical area. Hospitals 25 that utilize temporary nursing agencies shall have and adhere to a writ- 26 ten procedure to orient and evaluate personnel from such sources to 27 ensure adequate orientation and competency prior to inclusion in the 28 nurse-to-patient ratio. In the event of an emergency staffing situation 29 in which insufficient staffing may lead to unsafe patient care, nurses 30 may be temporarily assigned to a different unit or clinical area, 31 provided that such nurses shall be assigned patients appropriate to 32 their skill and competency level. The hospital shall establish a 33 consistent plan for addressing emergency staffing situations and monitor 34 outcomes. Emergencies are defined as natural disasters, declared emer- 35 gencies, mass casualty incidents or other events not reasonably antic- 36 ipated and planned for and not regularly occurring within the hospital. 37 3. Each hospital shall maintain accurate daily records showing: 38 (a) the number of patients admitted, released and present in each 39 nursing department or unit within such hospital; 40 (b) the individual acuity level of each patient present in each nurs- 41 ing department or unit within such hospital; and 42 (c) the identity and duty hours of each direct-care nurse in each 43 nursing department or unit within such hospital. 44 4. Each hospital shall maintain daily statistics, by nursing depart- 45 ment and unit, of mortality, morbidity, infection, accident, injury and 46 medical errors. 47 5. All records required to be kept pursuant to this section shall be 48 maintained for a period of seven years. 49 6. All records required to be kept pursuant to this section shall be 50 made available upon request to the department and to the public; 51 provided, however, that information released to the public shall comply 52 with the applicable patient privacy laws, rules and regulations, and 53 that in facilities operated pursuant to the correction law the identity 54 and hours of staff shall not be released to the public. 55 § 2833. Work assignment policy. 1. General. Each hospital shall 56 adopt, disseminate to direct-care nurses and comply with a written workA. 108--A 7 1 assignment policy, that meets the requirements of subdivisions two and 2 three of this section, detailing the circumstances under which a 3 direct-care nurse may refuse a work assignment. 4 2. Minimum conditions. At a minimum, the work assignment policy shall 5 permit a direct-care nurse to refuse an assignment: 6 (a) for which the nurse is not prepared by education, training or 7 experience to safely fulfill the assignment without compromising or 8 jeopardizing patient safety, the nurse's ability to meet foreseeable 9 patient needs or the nurse's license; or 10 (b) would otherwise violate the safe staffing requirements. 11 3. Minimum procedures. At a minimum, the work assignment policy shall 12 contain procedures for the following: 13 (a) reasonable requirements for prior notice to the nurse's supervisor 14 regarding the nurse's request and supporting reasons for being relieved 15 of an assignment or continued duty; 16 (b) where feasible, an opportunity for the supervisor to review the 17 specific conditions supporting the nurse's request, and to decide wheth- 18 er to remedy the conditions, to relieve the nurse of the assignment, or 19 to deny the nurse's request to be relieved of the assignment or contin- 20 ued duty; 21 (c) a process that permits the nurse to exercise the right to refuse 22 the assignment or continued on-duty status when the supervisor denies 23 the request to be relieved if: 24 (i) the supervisor rejects the request without proposing a remedy or 25 the proposed remedy would be inadequate or untimely, 26 (ii) the complaint and investigation process with a regulatory agency 27 would be untimely to address the concern, and 28 (iii) the employee in good faith believes that the assignment meets 29 conditions justifying refusal; and 30 (d) recognition that a nurse who refuses an assignment pursuant to a 31 work assignment policy as set forth in this section shall not be deemed, 32 by reason thereof, to have engaged in negligent or incompetent action, 33 patient abandonment, or otherwise to have violated any law relating to 34 nursing. 35 § 2834. Public disclosure of staffing requirements. Every hospital 36 shall: 37 1. post in a conspicuous place readily accessible to the general 38 public a notice prepared by the department setting forth a summary of 39 the safe staffing requirements applicable to that hospital together with 40 information about where detailed information about the hospital's staff- 41 ing plan and actual staffing may be obtained; 42 2. upon request, make copies of the documented staffing plan filed 43 with the department available to the public; and 44 3. upon request make readily available to the nursing staff within a 45 department or unit, during each work shift, the following information: 46 (a) a copy of the current staffing plan for that department or unit, 47 (b) documentation of the number of direct-care nurses required to be 48 present during the shift, based on the approved adopted acuity system, 49 and 50 (c) documentation of the actual number of direct-care nurses present 51 during the shift. 52 § 2835. Enforcement responsibilities. The department shall not dele- 53 gate its responsibilities to enforce the safe staffing requirements 54 promulgated pursuant to this article. 55 § 2836. Private right of action for violations of section twenty-eight 56 hundred thirty-three of this article. Any hospital that violates theA. 108--A 8 1 rights of an employee pursuant to an adopted work assignment policy 2 under section twenty-eight hundred thirty-three of this article may be 3 held liable to such employee in an action brought in a court of compe- 4 tent jurisdiction for such legal or equitable relief as may be appropri- 5 ate to effectuate the purposes of the safe staffing requirements, 6 including but not limited to reinstatement, promotion, lost wages and 7 benefits, and compensatory and consequential damages resulting from the 8 violation together with an equal amount in liquidated damages. The court 9 in such action shall, in addition to any judgment awarded to a prevail- 10 ing plaintiff, award reasonable attorneys' fees and costs of action to 11 be paid by the defendant. An employee's right to institute a private 12 action pursuant to this subdivision shall not be limited by any other 13 right granted by the safe staffing requirements. 14 § 4. Section 2801-a of the public health law is amended by adding a 15 new subdivision 3-b to read as follows: 16 3-b. In considering character, competence and standing in the communi- 17 ty under subdivision three of this section, the public health and health 18 planning council shall consider any past violations of state or federal 19 rules, regulations or statutes relating to employer-employee relations, 20 workplace safety, collective bargaining or any other labor related prac- 21 tices, obligations or imperatives. The public health and health planning 22 council shall give substantial weight to violations of the provisions of 23 this chapter concerning nurse staff and supportive staff ratios. 24 § 5. Section 2805 of the public health law is amended by adding a new 25 subdivision 3 to read as follows: 26 3. In determining whether to issue or renew an operating certificate 27 to an applicant seeking to operate, or operating, a hospital in accord- 28 ance with this article, the commissioner shall consider any past 29 violations of state or federal rules, regulations or statutes relating 30 to employer-employee relations, workplace safety, collective bargaining 31 or any other labor related practices, obligations or imperatives. The 32 public health and health planning council shall give substantial weight 33 to violations of the provisions of this chapter concerning nurse staff 34 and supportive staff ratios. 35 § 6. The public health law is amended by adding a new section 2895-b 36 to read as follows: 37 § 2895-b. Nursing home staffing levels. 1. Definitions. As used in 38 this section, the following terms shall have the following meanings: 39 (a) "Certified nurse aide" means any person included in the nursing 40 home nurse aide registry pursuant to section twenty-eight hundred 41 three-j of this chapter. 42 (b) "Staffing ratio" means the quotient of the number of personnel in 43 a particular category regularly on duty for a particular time period in 44 a nursing home divided by the number of residents of the nursing home at 45 that time. 46 2. Commissioner and nursing home council; powers and duties. The 47 commissioner shall: Appoint a nursing home council consisting of thir- 48 teen members. No less than two members shall be direct care licensed 49 practical nurses, no less than two members shall be direct care certi- 50 fied nurse assistants and no less than one member shall be a direct 51 care registered professional nurse. The council shall also include no 52 less than one representative each of recognized or certified collective 53 bargaining agents of registered nurses, of non-registered nurse direct 54 care staff and a representative of nursing professional associations. 55 The council shall also include no less than two representatives of nurs- 56 ing home operators, two representatives of nursing home nurse adminis-A. 108--A 9 1 trators and one representative of consumers. The nursing home council 2 shall advise the commissioner in the development of regulations relating 3 to the staffing standards under this section; and may from time to time, 4 report to the governor, the legislature, the public and the commissioner 5 any recommendations regarding staffing levels in nursing homes. 6 3. Staffing standards. (a) The commissioner, in consultation with the 7 council, shall, by regulation, establish staffing standards for nursing 8 home minimum staffing levels to meet applicable standards of service and 9 care and to provide services to attain or maintain the highest practica- 10 ble physical, mental, and psychosocial well-being of each resident of 11 the facility. The commissioner shall also require by regulation that 12 every nursing home maintain records on its staffing levels, report on 13 such records to the department, and make such records available for 14 inspection by the department. 15 (b) Every nursing home shall: 16 (i) comply with the staffing standards under this section; and 17 (ii) employ sufficient staffing levels to meet applicable standards of 18 service and care and to provide service and care and to provide services 19 to attain or maintain the highest practicable physical, mental, and 20 psychosocial well-being of each resident of the facility. 21 (c) Subject to subdivision five of this section, staffing standards 22 under this section shall, at a minimum, be the staffing standards under 23 subdivision four of this section. 24 (d) In determining compliance with the staffing standards under this 25 section, an individual shall not be counted while performing services 26 that are not direct nursing care, such as administrative services, food 27 preparation, housekeeping, laundry, maintenance services, or other 28 activities that are not direct nursing care. 29 4. Statutory standard. Beginning two years after the effective date 30 of this section, every nursing home shall maintain a staffing ratio 31 equal to at least the following: 32 (a) 2.8 hours of care per resident per day by a certified nurse aide; 33 (b) 1.3 hours of care per resident per day by a licensed practical 34 nurse or a registered nurse; 35 (c) 0.75 hours of care per resident per day by a registered nurse; the 36 minimum of 0.75 hours of care per resident provided by a registered 37 nurse shall be divided among all shifts to ensure an appropriate level 38 of registered nurse care twenty-four hours per day, seven days a week, 39 to meet resident needs; and 40 (d) Nursing homes that care for subacute patients shall maintain at a 41 minimum, the following direct-care nurse-to-patient ratio: one nurse to 42 five patients. 43 5. Any nursing home that violates the rights of an employee pursuant 44 to an adopted work assignment policy under this section may be held 45 liable to such employee in an action brought in a court of competent 46 jurisdiction for such legal or equitable relief as may be appropriate to 47 effectuate the purposes of the safe staffing requirements, including but 48 not limited to reinstatement, promotion, lost wages and benefits, and 49 compensatory and consequential damages resulting from the violation 50 together with an equal amount in liquidated damages. The court in such 51 action shall, in addition to any judgment awarded to a prevailing plain- 52 tiff, award reasonable attorneys' fees and costs of action to be paid by 53 the defendant. An employee's right to institute a private action pursu- 54 ant to this subdivision shall not be limited by any other right granted 55 by the safe staffing requirements.A. 108--A 10 1 6. Public disclosure of staffing levels. (a) A nursing home shall post 2 information regarding nurse staffing that the facility is required to 3 make available to the public under section twenty-eight hundred five-t 4 of this chapter. Information under this paragraph shall be displayed in 5 a form approved by the department and be posted in a manner which is 6 visible and accessible to residents, their families and the staff, as 7 required by the commissioner. 8 (b) A nursing home shall post a summary of this section, provided by 9 the department, in proximity to each posting required by paragraph (a) 10 of this subdivision. 11 § 7. If any provision of this act, or any application of any provision 12 of this act, is held to be invalid, or ruled by any federal agency to 13 violate or be inconsistent with any applicable federal law or regu- 14 lation, that shall not affect the validity or effectiveness of any other 15 provision of this act, or of any other application of any provision of 16 this act. 17 § 8. This act shall take effect on the one hundred eightieth day after 18 it shall have become a law. Effective immediately, the addition, amend- 19 ment and/or repeal of any rule or regulation necessary for the implemen- 20 tation of this act on its effective date are authorized to be made and 21 completed on or before such effective date.
