1Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
2act relating to health care; prescribing the powers and
3duties of the Department of Health; establishing and
4providing the powers and duties of the State Health
5Coordinating Council, health systems agencies and Health Care
6Policy Board in the Department of Health, and State Health
7Facility Hearing Board in the Department of Justice;
8providing for certification of need of health care providers
9and prescribing penalties," providing for professional nurse
10staffing standards.

11The General Assembly of the Commonwealth of Pennsylvania
12hereby enacts as follows:

13Section 1. The act of July 19, 1979 (P.L.130, No.48), known
14as the Health Care Facilities Act, is amended by adding a
15chapter to read:

16CHAPTER 8-A

17PROFESSIONAL NURSE STAFFING STANDARDS

18Section 801-A. Scope of chapter.

19This chapter relates to professional nurse staffing standards

1in general or special hospitals that will address patient safety
2and the delivery of quality nursing care to patients.

3Section 802-A. Definitions.

4The following words and phrases when used in this chapter
5shall have the meanings given to them in this section unless the
6context clearly indicates otherwise:

7"Direct patient care." Care provided by a staff member with
8direct responsibility to carry out medical regimens or nursing
9care for one or more patients.

10"Hospital unit." An area in a hospital where direct patient
11care is provided.

12"Professional nurse." An individual who holds a license to
13practice professional nursing under the act of May 22, 1951
14(P.L.317, No.69), known as The Professional Nursing Law.

15"Quality measures." Measures or indicators derived from
16various sources. The term includes, but is not limited to,
17claims and medical records that allow the organization to
18evaluate processes and outcomes of care and nursing-sensitive
19indicators endorsed by the National Quality Forum or that are
20part of the National Database for Nursing Quality Indicators.

21"Staffing committee." The professional nurse staffing
22committee or committees established under section 804-A.

23"Staffing plan." The professional nurse staffing plan
24established under section 803-A.

25Section 803-A. Organizational development of professional nurse
26staffing plan.

27A hospital shall develop, implement and monitor a
28professional nurse staffing plan for each hospital unit. The
29development of the plan shall occur internally by a professional
30nurse staffing committee or committees established under section

1804-A.

2Section 804-A. Professional nurse staffing committees.

3(a) Establishment.--A hospital shall establish at least one
4professional nurse staffing committee within 180 days of the
5effective date of this section. The staffing committee shall
6meet at least two times each year.

7(b) Membership.--The membership of the staffing committee
8shall be split evenly between professional nurses currently
9providing direct patient care in the hospital and administrative
10staff chosen by the hospital. The following shall apply:

11(1) Professional nurses currently providing direct
12patient care in the hospital shall be selected by their peers
13on an anonymous basis to serve on the committee.

14(2) Administrative staff may be appointed at the
15discretion of the board of directors or president of the
16hospital and shall include at least one individual with
17experience with the hospital's budget or financial condition.

18(c) Oversight.--The chairperson of the staffing committee
19shall ensure that the staffing committee develops a staffing
20plan for each unit and that the plans are evaluated.

21Section 805-A. Duties and responsibilities of hospital.

22A hospital shall have the following duties and
23responsibilities:

24(1) Establish the staffing committee required to develop
25the staffing plan prescribed in section 804-A within 120 days
26of the effective date of this section.

27(2) Provide the education and parameters necessary for
28staff to create a staffing plan given the available resources
29of the hospital so that staff can responsibly develop the
30staffing plan within 180 days of the effective date of this

1section.

2(3) Adopt the staffing plan in a timeline that is
3consistent with the hospital budgetary planning process.

4(4) Make accessible to all nursing staff the final and
5approved staffing plan for the units in the hospital.

6(5) Evaluate staffing plans and report to the staffing
7committee no less than twice annually.

8(6) Develop and implement a plan of action with the
9assistance of professional nurses providing direct patient
10care and other appropriate staff, if there is evidence of
11noncompliance with the staffing plan and the noncompliance
12with the staffing plan negatively impacts patients and
13professional nurses.

14(7) Establish a process by which immediate concerns
15about nurse staffing can be reported and addressed within
16nursing and inform the professional nurse staff of the
17process.

18(8) Develop mechanisms by which nursing staff can raise
19concerns and make recommendations about the staffing plans
20either through the existing staffing committee or nursing
21administration, or both.

22(9) Ensure that the chief nursing officer receives
23periodic reports from the staffing committee in a format
24developed by the hospital to ensure that consistent
25information is captured.

26(10) Receive reports from other hospital committees,
27including, but not limited to, the patient safety committee
28and quality committee, that may be related to nurse staffing.

29(11) Provide an annual report, for internal purposes, to
30the chief executive officer, the staffing committee and the

1governing board relating to nurse staffing, including, but
2not limited to, compliance with the approved nurse staffing
3plans and any actions taken to address nurse staffing issues.

4(12) Make available to all patients information on how
5to make a request for the staffing plan, including the
6appropriate person, office or department that may be
7contacted to review or obtain a copy of the plan.

8(13) Comply with act of December 12, 1986 (P.L.1559,
9No.169), known as the Whistleblower Law, and section
10307(b)(4) of the act of March 20, 2002 (P.L.154, No.13),
11known as the Medical Care Availability and Reduction of Error
12(Mcare) Act.

13Section 806-A. Duties and responsibilities of staffing
14committees.

15The staffing committee shall have the following duties and
16responsibilities:

17(1) Develop a staffing plan, in a timeline that is
18consistent with the hospital budgetary planning process, for
19each hospital unit as prescribed in section 803-A within 180
20days following the effective date of this section.

21(2) Elect a chairperson from within the staffing
22committee who is a professional nurse that provides direct
23patient care.

24(3) Develop a staffing plan that takes into
25consideration variables that can influence the staffing plan
26for that hospital unit. The variables include, but are not
27limited to, the following:

28(i) The special skills and competencies required by
29the nursing staff in that hospital unit to provide care
30to the hospital unit's patient population to ensure the

1delivery of quality care and quality outcomes.

2(ii) Staffing standards recommended by nationally
3recognized professional nursing organizations,
4particularly those that address professional standards of
5care for the selected patient population.

6(iii) Staff skill mix, specialty certification and
7years of experience.

8(iv) The numbers and types of other professional,
9paraprofessional or support staff that professional
10nurses must collaborate with or supervise to ensure the
11delivery of quality care and quality outcomes.

12(v) Patient volume, patient acuity, nursing care
13intensity and patient turnover issues that can affect the
14numbers and types of staff required for the patient
15population in a hospital unit.

16(vi) The time needed to complete various key nursing
17tasks, including, but not limited to, surveillance,
18patient assessment, patient education and discharge
19planning.

20(vii) The physical environment in which care is
21provided, including, but not limited to, the physical
22architecture of each hospital unit, patient location and
23available technology of the health care facility.

24(4) Approve the plan with a vote in favor of the plan of
25at least 66% of the professional nursing staff committee.

26(5) Ensure that the plan contains information informing
27professional nurses how to report concerns about
28noncompliance with the staffing plan to a person designated
29by the staffing committee.

30(6) Review the plan at least twice annually and adjust

1the plan as determined by the staffing committee in
2accordance with the provisions of this section.

3Section 807-A. Penalties.

4The department may impose an administrative penalty of $1,000
5per day upon any hospital not in compliance with this chapter.

6Section 808-A. Confidentiality.

7The following shall apply:

8(1) The department shall ensure confidentiality of any
9reports made under this chapter in accordance with the act of
10June 10, 2009 (P.L.1, No.1), known as the Preventable Serious
11Adverse Events Act.

12(2) The department shall ensure the confidentiality of
13the annual report required by section 805-A(11). The annual
14report shall not be included in the discovery process of any
15subsequent lawsuits filed against a hospital.

16Section 2. This act shall take effect in 180 days.