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PRINTER'S NO. 3712
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2244
Session of
2015
INTRODUCED BY MARSHALL, GINGRICH, DiGIROLAMO, FABRIZIO, DeLUCA,
WHITE, V. BROWN, D. COSTA, FRANKEL, GILLEN, NEUMAN, PETRI,
ROZZI AND VEREB, JULY 7, 2016
REFERRED TO COMMITTEE ON HEALTH, JULY 7, 2016
AN ACT
Providing for the compilation of daily nursing staff reports by
hospitals, for public posting of reports and for reporting to
the Department of Health; and imposing duties on the
Department of Health.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
CHAPTER 1
GENERAL PROVISIONS
Section 101. Short title.
This act shall be known and may be cited as the Hospital
Nursing Staff Report Card Act.
Section 102. Purpose.
The General Assembly finds and declares as follows:
(1) The purpose of this act is to provide the public
information about nurse staffing practices in hospitals in
this Commonwealth so that patients can make informed
decisions about their choices of health care providers.
(2) Information on nurse staffing levels, such as the
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nurse staffing plan, including the number of registered
nurses, licensed practical nurses, certified nursing
assistants and unlicensed assistive personnel on duty, should
be made available to the public in recognition of the fact
that hospital caregivers contribute to improved patient
safety and health care outcomes.
Section 103. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Actual hours worked." The actual hours worked by a nurse
providing direct patient care during any portion of the nurse's
shift. The term includes a nurse's fifteen-minute breaks. The
term does not include meal breaks, benefit time, vacation,
medical leave, orientation, education or committee time.
"Department." The Department of Health of the Commonwealth.
"Direct care nurse" and "direct care nursing staff." A unit-
based registered nurse, licensed practical nurse or certified
nursing assistant with direct responsibility to oversee or carry
out medical regiments or nursing care for one or more patients.
The term does not include caseworkers, educators or nurse
specialists, such as a stoma nurse specialist, cardiac
rehabilitation nurse or wound care nurse, who concentrates on
only one facet of a patient's care and who interacts with
multiple patients in various hospital units.
"Hospital." A health care facility licensed under the act of
July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act. The term includes critical access and long-term
acute care hospitals in both the private and public sector.
"Long-term acute care hospital." A hospital or health care
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facility that specializes in providing acute care to medically
complex patients with an anticipated length of stay of more than
25 days. The term includes a free-standing and a hospital-
within-hospital model long-term acute care facility.
"Nursing care." A care service that falls within the scope
of practice set forth in the act of May 22, 1951 (P.L.317,
No.69), known as The Professional Nursing Law, or is otherwise
encompassed within recognized professional standards of nursing
practice, including assessment, nursing diagnosis, planning,
intervention, evaluation, patient teaching, discharge planning
and patient advocacy.
"Overflow." When the volume of patients outnumbers the beds
of a licensed unit and the beds in another licensed unit are
used for those patients.
"Patient care unit." A unit within a hospital that:
(1) is a specific geographical or physical location
within the hospital;
(2) is designated a specific cost center; or
(3) provides clinical services by a generic class of
levels of support functions, equipment, care or treatment
provided to inpatients.
"Shift." A standardized reporting period based upon the
actual standard of scheduling shifts common to the hospital to
be reported as either three eight-hour periods, consisting of
morning, evening and night periods, or two twelve-hour periods,
consisting of day and night. The emergency room and the post-
anesthesia care unit, in those hospitals where the post-
anesthesia care unit is open twenty-four hours daily, shall
report a twenty-four hour shift.
"Sitters." Companions to patients at high risk of falls,
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suicide or other conditions.
"Turnover rate." The percentage of direct care nursing staff
that leaves a unit, either voluntarily or involuntarily.
"Unlicensed assistive personnel." An unlicensed individual
who is trained to function in an assistive role to the licensed
nurse in the provision of patient/client activities as delegated
by the nurse.
CHAPTER 2
NURSING STAFF REPORTING
Section 201. Nursing staff report.
(a) General rule.--A hospital shall compile a daily report
on each patient care unit and shift containing the following
information:
(1) The number of each of the following types of staff
per four-hour time period providing direct patient care:
(i) Registered nurses.
(ii) Licensed practical nurses.
(iii) Certified nursing assistants.
(iv) Unlicensed personnel.
(2) The relative number of patients to each of the
following types of staff:
(i) Registered nurses.
(ii) Licensed practical nurses.
(iii) Certified nursing assistants.
(iv) Unlicensed personnel.
(3) The current direct care nurse staffing schedule and
assignment roster.
(4) The availability, by number of hours on the shift,
that a unit clerk or unit secretary is available exclusively
for the specified patient care unit.
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(5) Whether patients requiring scheduled or emergency
respiratory treatments have had treatments that were
administered by a respiratory therapist or the direct care
nursing staff of the unit.
(6) Percentage of temporary or agency nurses included in
the shift staff.
(7) The methods used by the hospital for determining and
adjusting staffing levels.
(8) The registered nurse, licensed practical nurse and
certified nursing assistant turnover rate for the previous
month.
(9) The number and types of complaints under the act of
June 10, 2009 (P.L.1, No.1), known as the Preventable Serious
Adverse Events Act, filed with the hospital concerning
patient care for the previous month.
(b) Reporting method.--The report required under subsection
(a) shall be compiled as follows:
(1) For each inpatient unit, a hospital shall count the
number of patients and direct care nursing staff based on
hours worked for each category of direct care nursing staff,
excluding other licensed health care professionals, one hour
before the end of each shift.
(2) For each emergency department, a hospital shall
count the number of patients registered during the four-hour
shift and the number of direct care nursing staff based on
hours worked for each category of direct care nursing staff,
excluding other licensed health care professionals, one hour
before the end of each shift.
(3) For each post-anesthesia care unit, a hospital shall
count the number of patients that were in the post-anesthesia
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care unit during the shift and the number of direct care
nursing staff, based on hours worked for each category of
direct care nursing staff, excluding other licensed health
care professionals, one hour before the end of each shift.
(4) For each mother and baby unit, hospitals shall
report direct care nursing staff hours under the obstetrics
unit, not the newborn nursery. A mother and baby should each
be reported as a separate patient.
(5) For each psychiatric and behavioral unit, licensed
mental health counselors, activity therapists and
recreational therapists providing direct patient care shall
be considered as licensed practical nurses. Staffing hours
for unlicensed mental health technicians or other unlicensed
personnel will be included as unlicensed personnel hours.
(6) Graduate nurses who participate in an internship
program shall not be included in determining the relative
number of patients to direct care nursing staff, except
orientee or graduate nurse hours shall be included when the
graduate nurse has completed the designated time-defined
orientation and reaches the point where the graduate nurse is
considered part of the staff matrix, the graduate nurse's
work hours are charged to the unit and the graduate nurse is
replaced if the nurse calls in sick.
(7) When a direct care nurse works beyond the nurse's
shift into the next shift, the actual hours should be
included in the daily posting forms for all shifts that the
nurse worked.
(8) Hospital management and support staff who do not
provide direct patient care may not be included in the daily
reporting forms.
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(9) Sitters, including registered nurses acting as
sitters, will be considered unlicensed assistive personnel
only if they provide other direct patient care in addition to
observation. Sitters providing only companion service may not
be included in the actual hours worked for unlicensed
assistive personnel.
(10) When overflow beds are used for patients, the
patients shall be included in the daily report of the patient
care unit where the patient is receiving care.
(11) The staff relative number reporting shall be to one
decimal point. If a hospital patient care unit does not have
any direct care nursing staff for a particular category, a
zero should be entered on the report for that staff category.
Section 202. Posting.
A hospital shall post the report required under section 201
as follows:
(1) The report shall be posted no later than one hour
after the beginning of a shift with respect to each shift.
(2) The report shall be prominently displayed in a
location visible to the public on the patient unit.
(3) The report shall be easily readable in its posted
form.
Section 203. Submission of report to department.
A hospital shall submit the daily reports for the previous
month to the department no later than the 15th day of each
month.
Section 204. Retention of records.
All daily reports and records required to compile the report
under section 201 shall be retained by the hospital for a period
of five years and be posted on the hospital's publicly
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accessible Internet website.
Section 205. Exclusions.
The following apply:
(1) Outpatient units are excluded from reporting
requirements under this act.
(2) Patients under observation status are excluded from
reporting requirements under this act.
Section 206. Divisions and subsidiaries.
If a hospital is a division or subsidiary of another entity
that owns or operates another hospital or related organizations,
the report under section 201 shall be for the specific division
or subsidiary and not for any other entity.
Section 207. Whistleblower protection.
(a) General rule.--A hospital shall not discriminate,
retaliate in any manner, intimidate, threaten or punish an
employee with respect to compensation or the terms, conditions
or privileges of employment when the employee in good faith,
individually or in conjunction with another person, does any of
the following:
(1) Discloses to a nursing staff supervisor or manager,
a private accreditation organization, a nurse's collective
bargaining agent or a regulatory agency, any activity, policy
or practice of a hospital that violates this act or other law
or rule or that the employee believes poses a risk to the
health, safety or welfare of a patient or the public.
(2) Initiates, cooperates or otherwise participates in
an investigation or proceeding brought by a regulatory agency
or private accreditation body concerning matters covered by
this act or any law or rule that the employee reasonably
believes poses a risk to the health, safety or welfare of a
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patient or the public.
(3) Objects or refuses to participate in any activity,
policy or practice of a hospital that violates this act or
any law or rule the department or a reasonable person would
believe poses a risk to the health, safety and welfare of a
patient or the public.
(4) Participates in a committee or peer review process
or files a report of complaint that discusses allegations of
unsafe, dangerous or potentially dangerous care within a
hospital.
(b) Employee good faith.--An employee is presumed to act in
good faith if the employee reasonably believes the following:
(i) The information reported or disclosed is true.
(ii) A staffing violation has occurred or may occur.
(c) Notice to hospital.--
(1) The protection under subsection (a) shall not apply
to an employee unless the employee gives written notice to a
direct nursing supervisor or direct nursing manager of the
activity, policy, practice or violation that the employee
believes poses a risk to the health of a patient or the
public and provides the manager a reasonable opportunity to
correct the problem.
(2) The direct nursing supervisor or direct nursing
manager shall respond in writing to the employee within seven
days to acknowledge that the notice was received. The direct
nursing supervisor or direct nursing manager shall provide
written notice of any action taken within a reasonable time
of receiving the employee's notice.
Section 208. Forms.
The department shall develop standardized reporting forms to
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be used in all hospitals for reporting under this act.
Section 209. Quarterly Reports.--
(a) General rule.--The department shall produce a quarterly
report for each hospital that shows the average direct care
nurse staffing levels for each unit for a three-month period as
follows:
(1) Relative number of patients to staff for each type
of patient care unit.
(2) Turnover rate for direct care nursing staff.
(3) Percentage of contractual direct care nursing staff
utilized.
(4) Daily numbers of direct care nursing staff and
patients in the emergency department.
(5) Daily number of nonregistered nurse health care
practitioners.
(b) Posting.--The quarterly reports produced by the
department shall be made available to the public on the same
Internet website as the quality control measures reporting for
health care facilities. The department shall post quarterly
reports January 31, April 30, July 31 and October 31 of each
year. The data in the quarterly reports must cover a period
ending not earlier than one month prior to submission of the
report.
Section 210. Monitoring.
The department shall be responsible for monitoring the
reports from all hospitals in this Commonwealth for variances
between periods and to compare the reports to the reported
quality control measures to determine if there are correlations
or deficiencies in the quality measures.
Section 211. Compliance by hospitals.
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The department shall be responsible for ensuring compliance
with this act as a condition of licensure under the act of July
19, 1979 (P.L.130, No.48), known as the Health Care Facilities
Act, and shall enforce compliance in accordance with the
provisions of the Health Care Facilities Act.
CHAPTER 3
MISCELLANEOUS PROVISIONS
Section 301. Effective date.
This act shall take effect in 90 days.
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