THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY ADOLPH, MUNDY, HENNESSEY, DENLINGER, DePASQUALE, SONNEY, BARBIN, BARRAR, BOBACK, CARROLL, COHEN, D. COSTA, DALEY, DAVIDSON, DeLUCA, DiGIROLAMO, DONATUCCI, DUNBAR, FABRIZIO, GALLOWAY, GEORGE, GIBBONS, GINGRICH, GODSHALL, GOODMAN, GROVE, HARHART, HARKINS, HARPER, HESS, HORNAMAN, JOSEPHS, F. KELLER, M. K. KELLER, W. KELLER, KILLION, KORTZ, KOTIK, MARSHALL, MICOZZIE, MILNE, MULLERY, MURPHY, MURT, M. O'BRIEN, PASHINSKI, PETRI, RAVENSTAHL, ROEBUCK, SAINATO, SANTONI, SIMMONS, STERN, THOMAS, WATSON AND YOUNGBLOOD, SEPTEMBER 29, 2011

REFERRED TO COMMITTEE ON HEALTH, SEPTEMBER 29, 2011  

AN ACT

Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An

act relating to health care; prescribing the powers and

duties of the Department of Health; establishing and

providing the powers and duties of the State Health

Coordinating Council, health systems agencies and Health Care

Policy Board in the Department of Health, and State Health

Facility Hearing Board in the Department of Justice;

providing for certification of need of health care providers

and prescribing penalties," providing for professional nurse

staffing standards.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  The act of July 19, 1979 (P.L.130, No.48), known

as the Health Care Facilities Act, is amended by adding a

chapter to read:

CHAPTER 8-A

PROFESSIONAL NURSE STAFFING STANDARDS

Section 801-A.  Scope of chapter.

This chapter relates to professional nurse staffing standards

in general or special hospitals that will address patient safety

and the delivery of quality nursing care to patients.

Section 802-A.  Definitions.

The 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:

"Direct patient care."  Care provided by a professional nurse

with direct responsibility to carry out medical regimens or

nursing care for one or more patients.

"Hospital unit."  An area in a hospital where direct patient

care is provided.

"Professional nurse."  An individual 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.

"Quality measures."  Measures or indicators derived from

various sources. The term includes, but is not limited to,

claims and medical records that allow the organization to

evaluate processes and outcomes of care and nursing sensitive

indicators endorsed by the National Quality Forum or that are

part of the National Database for Nursing Quality Indicators.

"Staffing committee."  The professional nurse staffing

committee or committees established under section 804-A.

"Staffing plan."  The professional nurse staffing plan

established under section 803-A.

Section 803-A.  Organizational development of professional nurse

staffing plan.

A hospital shall develop, implement and monitor a

professional nurse staffing plan for each hospital unit. The

development of the plan shall occur internally by a professional

nurse staffing committee or committees established under section

804-A.

Section 804-A.  Professional nurse staffing committees.

(a)  Establishment.--A hospital shall establish at least one

professional nurse staffing committee within 60 days of the

effective date of this section. The committee shall meet at

least three times each year.

(b)  Membership.--The majority of the members of a

professional nurse staffing committee shall be professional

nurses currently providing direct patient care in the hospital.

Professional nurses shall be selected by their peers to serve on

the committee. Hospital and nursing administration and the

elected chairperson of the professional nurse staffing committee

may determine other staff to be represented on the committee.

(c)  Oversight.--The hospital chief nursing officer shall

ensure that the staffing committee develops a staffing plan for

each unit and that the plans are evaluated.

Section 805-A.  Duties and responsibilities of hospital.

A hospital shall have the following duties and

responsibilities:

(1)  Establish the committee required to develop the

staffing plan prescribed in section 804-A within 60 days of

the effective date of this section.

(2)  Provide the education and parameters necessary for

staff to create a staffing plan given the available resources

of the hospital so that staff can responsibly develop the

staffing plan within 120 days of the effective date of this

section.

(3)  Adopt the staffing plan in a timeline that mirrors

the hospital budgetary planning process.

(4)  Make accessible to all nursing staff the final and

approved staffing plan for the units in the hospital.

(5)  Evaluate adherence to the adopted staffing plans no

less than twice annually.

(6)  Enlist the assistance of frontline nursing staff,

appropriate managers and human resources, as necessary, to

develop and implement a plan of action when there is evidence

of noncompliance with the staffing plan and the noncompliance

is negatively impacting patients and nurses.

(7)  Establish a process by which immediate concerns

about nurse staffing can be reported and addressed within

nursing.

(8)  Develop mechanisms by which nursing staff can raise

concerns and make recommendations about the unit staffing

plans either through the existing committee or nursing

administration, or both.

(9)  Ensure that the chief nursing officer receives

periodic reports from the staffing committee in a format

developed by the hospital to ensure that consistent

information is captured.

(10)  Receive reports from other hospital committees,

including, but not limited to, the patient safety committee

and quality committee, that may be related to nurse staffing.

(11)  Provide an annual report to the chief executive

officer and governing board relating to nurse staffing,

including, but not limited to, compliance with the approved

nurse staffing plans and any actions taken to address nurse

staffing issues.

(12)  Post notices and use other means to make the

general public aware that staffing plans will be made

available upon request. The information shall include how to

make a request, including the appropriate person, office or

department that may be contacted to review or obtain a copy

of the plan.

(13)  Make available a copy of the relevant staffing plan

to any person who requests it for a fee not to exceed the

actual copying costs incurred by the hospital.

(14)  Prohibit any retaliatory action against a

professional nurse 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, and section 307(4)

of the act of March 20, 2002 (P.L.154, No.13), known as the

Medical Care Availability and Reduction of Error (Mcare) Act.

Section 806-A.  Duties and responsibilities of committees.

The committee shall have the following duties and

responsibilities:

(1)  Develop a plan prescribed in section 803-A within

120 days following the effective date of this section.

(2)  Establish a professional nurse staffing plan for

each hospital unit.

(3)  Elect a chairperson from within the committee who is

a professional nurse that provides direct patient care.

(4)  Develop a staffing plan that takes into

consideration variables that can influence the staffing plan

for that hospital unit. The variables include, but are not

limited to, the following:

(i)  The special skills and competencies required by

the nursing staff in that hospital unit to provide care

to the hospital unit's patient population to ensure the

delivery of quality care and quality outcomes.

(ii)  Staffing standards recommended by nationally

recognized professional nursing organizations,

particularly those that address professional standards of

care for the selected patient population.

(iii)  Staff skill mix, specialty certification and

years of experience.

(iv)  The numbers and types of other professional,

paraprofessional or support staff that nurses must

collaborate with or supervise to ensure the delivery of

quality care and quality outcomes.

(v)  Patient volume, patient acuity, nursing care

intensity and patient turnover and throughput issues that

can affect the numbers and types of staff required for

the patient population in a hospital unit.

(vi)  The time needed to complete various key nursing

tasks, including, but not limited to, surveillance,

patient assessment, patient education and discharge

planning.

(vii)  The physical environment in which care is

provided, including, but not limited to, the physical

architecture of each hospital unit, patient location and

available technology of the health care facility.

(5)  Ensure that the plan contains information informing

professional nurses how to report concerns about

noncompliance with the staffing requirement of the plan to a

person designated by the committee. If, after investigation

and consideration by the committee or other hospital and

nursing administration, the issue is not resolved, the nurse

who raised the concern may file a complaint with the

department.

Section 807-A.  Powers and duties of the department.

For purposes of this chapter, the department may:

(1)  Adopt and promulgate any regulations it deems

necessary to carry out the purposes and provisions of this

chapter.

(2)  Review and investigate as it deems necessary any

reported violations of this chapter.

(3)  Impose an administrative penalty of $1,000 per day

upon any hospital not in compliance.

(4)  Ensure confidentiality of reports in accordance with

the act of June 10, 2009 (P.L.1, No.1), known as the

Preventable Serious Adverse Events Act.

Section 2.  This act shall take effect in 60 days.