H0574B1521A01781     MSP:EAZ  05/04/11     #90        A01781

AMENDMENTS TO HOUSE BILL NO. 574

Sponsor: REPRESENTATIVE FRANKEL

Printer's No. 1521

Amend Bill, page 1, line 10, by inserting after "license"

; providing for professional nurse safe staffing standards

Amend Bill, page 5, by inserting between lines 10 and 11

Section 3.1.  The act is amended by adding a chapter to read:

CHAPTER 8-A

PROFESSIONAL NURSE SAFE STAFFING STANDARDS

Section 801-A.  Scope of chapter.

This chapter relates to professional nurse staffing standards

in a general or special hospital, or ambulatory surgical

facility that will ensure patient safety and the delivery of

quality health care to patients.

Section 802-A.  Definitions.

For the purposes of this chapter, following words and phrases

when used in this chapter shall have the meanings given to them

in this section unless the context clearly indicates otherwise:

"Acuity system."  A measurement system that is based on

scientific data and compares the registered nurse staffing level

in each nursing department or unit against actual nursing care

requirements of each patient, taking into consideration the

health care work force on duty and available to work appropriate

to their level of training or education, in order to predict

registered nursing direct-care requirements for individual

patients based on the severity of patient illness. The system

shall be both practical and effective in terms of hospital

implementation.

"Direct-care registered nurse."  A registered nurse who has

accepted direct responsibility and accountability to carry out

medical regimens, nursing or other bedside care for patients.

"Direct patient care."  Care provided by a nurse with direct

responsibility to carry out medical regimens or nursing care for

one or more patients.

"Health care facility."  A general or special hospital, or

ambulatory surgical facility.

"Health care worker."  An employee, independent contractor,

licensee or other individual authorized to provide services in a

medical facility.

"Patient safety officer."  An individual designated by a

medical facility under section 309 of the act of March 20, 2002

(P.L.154, No.13), known as the Medical Care Availability and

Reduction of Error (Mcare) Act.

"Professional nurse."  Any person who holds a license to

practice professional nursing under the act of May 22, 1951

(P.L.317, No.69), known as The Professional Nursing Law.

"Safe staffing committee" or "committee."  The Professional

Nurse Safe Staffing Committee established under section 804-A.

"Safe staffing plan" or "plan."  The professional nurse safe

staffing plan established under section 806-A.

Section 803-A.  Development of professional nurse safe staffing

standards.

A health care facility shall develop, validate and implement

a professional nurse safe staffing plan for the purpose of

ensuring the health and safety of patients. The plan shall be

developed internally by a Professional Nurse Safe Staffing

Committee established under section 804-A which shall include as

members professional nurses providing direct care to patients in

the facility.

Section 804-A.  Professional Nurse Safe Staffing Committee.

(a)  Establishment.--A health care facility shall establish a

Professional Nurse Safe Staffing Committee no later than 60 days

following the effective date of this chapter. The committee

shall meet at least three times per year.

(b)  Membership.--Members of the committee shall include the

chief nursing officer, a member of the medical staff and the

patient safety officer if the facility has designated one. At

least 50% of the individuals selected to serve on the committee

shall consist of professional nurses who provide direct patient

care in the facility. Selection of professional nurses to the

committee shall be made in a manner to ensure adequate committee

representation of all the types of nursing care provided in the

facility.

(c)  Existing committees.--Any committee or other similar

group established by a health care facility to engage in issues

related to nurse staffing standards prior to the effective date

of this chapter shall be required to conform to the provisions

of this chapter within 60 days of its effective date.

Section 805-A.  Duties and responsibilities of committee.

The committee shall have the following duties and

responsibilities:

(1)  Develop and adopt a plan prescribed in section 806-A

no later than 120 days following the enactment of this

chapter.

(2)  Evaluate the plan on an ongoing basis by collecting

nursing-sensitive indicators including:

(i)  Patient falls.

(ii)  Pressure ulcers.

(iii)  Staff mix.

(iv)  Hours per patient day.

(v)  Nursing staff satisfaction.

(vi)  Patient satisfaction with:

(A)  Nursing care.

(B)  Overall care.

(C)  Pain management.

(D)  Patient education.

(vii)  Turnover and vacancy rates.

(viii)  Overtime use.

(ix)  Use of supplemental staffing.

(x)  Musculoskeletal injuries.

(xi)  Flexibility of human resource policies and

benefit packages.

(xii)  Evidence of compliance with Federal, State and

local regulations.

(xiii)  Levels of nurse staff satisfaction.

(3)  Revise the plan as it affects each inpatient unit

based on the most recent evaluation of the plan, if

necessary.

(4)  Develop or adopt a patient acuity system containing,

at a minimum, the standards set forth in section 807-A.

(5)  Receive reports from the patient safety officer or

other designated person under section 809-A.

(6)  Ensure the investigation of all reports of any

noncompliance with the plan, and take such action as is

immediately necessary to ensure compliance.

(7)  Annually report to the administrative officer and

governing body of the health care facility regarding the

effectiveness of the plan and any revisions made to the plan.

(8)  Establish a mechanism for obtaining input from

professional nurses in all inpatient care units who provide

direct patient care for the purpose of developing, reviewing

and revising the plan.

Section 806-A.  Professional nurse safe staffing plan.

(a)  Establishment.--A plan shall be established for each

inpatient unit. The plan shall be, at a minimum, consistent with

current staffing standards established by health accreditation

organizations or national professional nursing organizations.

(b)  Guidelines.--The plan shall be based on nursing and

patient factors that yield appropriate staffing levels to ensure

that the health care facility has a staff of competent

professional nurses with specialized skills needed to meet

patient needs. The factors to be considered shall include but

not be limited to:

(1)  The characteristics of the nursing staff including,

at a minimum, staff consistency, skill mix, preparation and

clinical experience and the competency of clinical and

nonclinical support staff the nurse must collaborate with or

supervise.

(2)  Patient acuity as determined by the health care

facility's patient acuity system under section 807-A.

(3)  Patient volume.

(4)  Unit activity, including the amount of time needed

for patient education, ongoing physical assessments, new

admissions, discharges and transfers.

(5)  The physical environment in which care is provided

including the physical architecture of each unit, patient

location and available technology of the health care

facility.

(c)  Reporting system.--The plan shall also contain

information informing health care workers about the confidential

reporting system established by the department under section

809-A for the reporting of any occurrence of noncompliance with

the staffing requirements of the plan.

Section 807-A.  Patient acuity system.

Every health care facility shall be required to adopt and

utilize a patient acuity system that shall include the following

standards:

(1)  The availability of specialized equipment and

technology.

(2)  The number of patients requiring care.

(3)  The level of intensity of nursing interventions

required and the complexity of clinical nursing judgment

needed to design, implement and evaluate the nursing care

plan for each patient that is consistent with professional

standards of care.

(4)  The amount of nursing care needed, both in number of

direct-care professional nurses and skill mix of nursing

personnel required on a daily basis for each unit, the

proximity of patients, the proximity and availability of

other resources, facility design and personnel that have an

effect upon the delivery of quality patient care.

(5)  Patient care services provided by professional

nurses and licensed practical nurses and other health care

personnel.

Section 808-A.  Duties and responsibilities of health care

facility.

For purposes of this chapter, a health care facility shall

have the following duties and responsibilities:

(1)  Within 30 days from the date on which the committee

adopts its initial plan following the effective date of this

chapter, and no later than November 1 of each year

thereafter, validate the adopted plan and patient acuity

system along with a written certification by its chief

nursing officer that the plan is sufficient to provide

adequate and appropriate delivery of health care services to

patients for the ensuing year.

(2)  Provide copies of its plan in accordance with each

of the following:

(i)  Each professional nurse working within a

facility shall receive a copy of the plan for each unit

to which the nurse is assigned.

(ii)  Except as prescribed in subparagraph (i), a

copy of the plan shall be provided to any person who

requests it for a fee not to exceed the actual copying

cost incurred by the facility.

(3)  Post a notice in a conspicuous location within the

facility informing the general public of the availability of

the plan. The notice shall specify the appropriate person,

office or department to be contacted to review or obtain a

copy of the plan.

(4)  Prohibit any retaliatory action against a health

care worker for reporting a violation of this chapter in

accordance with the act of December 12, 1986 (P.L.1559,

No.169), known as the Whistleblower Law.

Section 809-A.  Reporting and whistleblower protection.

(a)  General rule.--A person who reasonably believes that the

health care facility is not in compliance with the professional

nurse staffing levels in the facility's plan shall immediately,

or as soon thereafter as reasonably practicable, report the

violation to the patient safety officer, who shall submit a

report of the alleged violation to the committee. If the

facility does not employ a patient safety officer, an

appropriate person shall be designated by the committee to

handle the reports.

(b)  Procedure.--A person who has complied with subsection

(a) may file an anonymous report regarding a violation of the

plan with the department. Upon receipt of the report, the

department shall give notice to the affected health care

facility that a report has been filed and require the facility

to take whatever action is necessary to become compliant with

the plan. The health care facility shall provide the department

with a statement describing the actions taken no later than 30

days after receiving notice under this subsection. At any time

the department deems necessary, the department may conduct its

own review and investigation of the report to ensure that the

facility is in compliance with the plan.

(c)  Protection.--A health care facility shall not

discriminate or take retaliatory action against a health care

worker or any other person who discloses a policy or practice of

the facility that an employee or person believes violates this

chapter. Discriminating or retaliatory actions shall include

discharge from employment, suspension, demotion, harassment,

denial of employment or promotion, layoff of nursing staff or

other adverse action.

Section 810-A.  Powers and duties of the department.

For purposes of this chapter, the department shall have the

power and its duties shall be:

(1)  To adopt and promulgate any regulations necessary to

carry out the purposes and provisions of this chapter.

(2)  To establish a confidential reporting system under

section 809-A(b) and inform each health care facility about

the reporting system.

(3)  To review and investigate as necessary any reported

violations of this chapter.

Section 811-A.  Penalties.

In addition to any penalty which may be imposed under this

act, a health care facility which fails to comply with any

provision of this chapter may be subject to an administrative

penalty of $1,000 per day imposed by the department.