S0115B0473A01555 SFR:JSL 06/09/21 #90 A01555
AMENDMENTS TO SENATE BILL NO. 115
Sponsor: REPRESENTATIVE KOSIEROWSKI
Printer's No. 473
Amend Bill, page 30, by inserting between lines 4 and 5
Section 5. 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.
(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 who are
employed by an outside entity 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 reports required under subsection
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(a) shall be compiled as follows:
(1) For each patient care 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 postanesthesia care unit, a hospital shall
count the number of patients that were in the postanesthesia
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, a hospital 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.
(9) Sitters, including registered nurses acting as
sitters, will be considered unlicensed assistant 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
assistant personnel.
(10) When overflow beds are used for patients, the
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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
a direct care nursing staff for a particular category, a zero
should be entered on the report for that staff category.
Section 6. Report posting.
(a) General rule.--A hospital shall post the report required
under section 5 as follows:
(1) The report, with respect to each shift, shall be
posted no later than one hour after the beginning of the next
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.
(b) Submission to department.--A hospital shall submit the
reports required under section 5 for the previous month to the
Department of Health of the Commonwealth no later than the 15th
day of each month.
(c) Retention of records.--Reports and records required to
be compiled under section 5(a) shall be retained by the hospital
for a period of five years and be posted on the hospital's
publicly accessible Internet website.
(d) Divisions and subsidiaries.--If a hospital is a division
or subsidiary of another entity that owns or operates another
hospital or related organizations, the reports under section 5
shall be for the specific division or subsidiary and not for
another entity.
Section 7. Whistleblower protection.
(a) General rule.--A hospital shall not discriminate,
retaliate, 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,
private accreditation organization, nurse's collective
bargaining agent or regulatory agency, an 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 a law or rule that the employee reasonably
believes poses a risk to the health, safety or welfare of a
patient or the public.
(3) Objects or refuses to participate in an activity,
policy or practice of a hospital that violates this act or a
law or rule the department or a reasonable person would
believe poses a risk to the health, safety and welfare of a
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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:
(1) The information reported or disclosed is true.
(2) 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 an action taken within a reasonable time of
receiving the employee's notice.
(d) Forms.--The Department of Health of the Commonwealth
shall develop standardized reporting forms to be used in all
hospitals for reporting under this section.
Section 8. Quarterly reports.
(a) General rule.--The Department of Health of the
Commonwealth 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 under
subsection (a) shall be made available to the public on the same
publicly accessible Internet website as the quality control
measures reporting for health care facilities. The Department of
Health of the Commonwealth 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 9. Monitoring.
The Department of Health of the Commonwealth shall be
responsible for monitoring the reports from all hospitals in
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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 control measures.
Section 10. Compliance by hospitals.
The Department of Health of the Commonwealth 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.
Amend Bill, page 30, line 5, by striking out "5" and
inserting
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