PRINTER'S NO. 3037
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2092
Session of
2018
INTRODUCED BY WARD, MURT, DiGIROLAMO, COX, BARRAR, O'BRIEN,
A. HARRIS, FREEMAN, KORTZ, READSHAW, MILLARD, D. COSTA,
WATSON, KAVULICH, BOBACK, WHEELAND, RADER, M. QUINN, GABLER,
BENNINGHOFF, PHILLIPS-HILL, TOOHIL, PETRARCA, M. K. KELLER,
MULLERY, HENNESSEY, ZIMMERMAN AND STURLA, FEBRUARY 26, 2018
REFERRED TO COMMITTEE ON HEALTH, FEBRUARY 26, 2018
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
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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
who has accepted the 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. The term shall include a long-term acute care
unit.
"Long-term acute care unit." A unit of a hospital whose
patients have a length of stay greater than 25 days and that
provides specialized acute care of medically complex patients
who are critically ill.
"Magnet hospital." A hospital recognized by the American
Nurses Credentialing Center as a magnet or pathway to excellence
hospital.
"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 including, but
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
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established under section 803-A.
"Unforeseeable emergent circumstance." Any of the following:
(1) An unforeseeable declared national, State or
municipal emergency.
(2) A highly unusual or extraordinary event which
substantially affects the provision of needed health care
services or increases the need for health care services,
including:
(i) an act of terrorism;
(ii) a natural disaster; and
(iii) a widespread disease outbreak.
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 and shall be made available to the department as
established under section 808-A .
Section 804-A. Staffing committees.
(a) Establishment.--A hospital shall establish at least one
staffing committee within 120 days of the effective date of this
section. The staffing committee shall meet at least two times
each year.
(b) Membership.--The membership of the staffing committee
shall be split evenly between professional nurses currently
providing direct patient care in the hospital and administrative
staff. The following shall apply:
(1) Professional nurses currently providing direct
patient care in the hospital shall be selected by their peers
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on an anonymous basis to serve on the committee.
(2) Administrative staff may be appointed at the
discretion of the board of directors or president of the
hospital and shall include at least one individual with
experience with the hospital's budget or financial condition.
(3) For a hospital recognized as a magnet hospital, the
administrative staff shall include at least one individual
with experience of the magnet recognition process.
(c) Oversight.--The chairperson of the staffing committee
shall ensure that the staffing committee develops a staffing
plan as required in section 803-A and that the plan is evaluated
by the hospital at least twice annually.
(d) Vacancies.--If a vacancy occurs on the staffing
committee, the vacant position shall be filled no later than 60
days after notice of the vacancy and shall follow the parameters
for membership as provided for under subsection (b).
Section 805-A. Duties and responsibilities of staffing
committees.
The staffing committee shall have the following duties and
responsibilities:
(1) Develop a staffing plan, in a timeline that is
consistent with the hospital budgetary planning process, as
prescribed in section 803-A within 180 days following the
effective date of this section.
(2) Elect a chairperson from within the staffing
committee who is a professional nurse that provides direct
patient care.
(3) 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
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limited to, the following:
(i) The 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 professional
nurses must collaborate with or supervise to ensure the
delivery of quality care and quality outcomes.
(v) Quality measures, patient volume, patient
acuity, nursing care intensity and patient turnover
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.
(viii) Routine fluctuations, such as admissions,
discharges and transfers.
(4) Approve the plan with a vote in favor of the plan of
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at least 66% of the staff committee.
(5) Ensure that the plan contains information informing
professional nurses how to report concerns about
noncompliance with the staffing plan to a person designated
by the staffing committee.
(6) Review the plan at least twice annually and adjust
the plan as determined by the staffing committee in
accordance with the provisions of this section and review
information received from the hospital under section 806-A.
Section 806-A . Duties and responsibilities of hospital.
A hospital shall have the following duties and
responsibilities:
(1) Establish the staffing committee required to develop
the staffing plan prescribed in section 804-A within 120 days
of the effective date of this section.
(2) Provide the education and parameters necessary for
the committee to create a staffing plan given the available
resources of the hospital so that the committee can
responsibly develop the staffing plan within 180 days of the
effective date of this section.
(3) Adopt the staffing plan in a timeline that is
consistent with the hospital budgetary planning process.
(4) Make accessible to all professional nursing staff
the final and approved staffing plan for the units in the
hospital.
(5) Evaluate the staffing plan and report to the
staffing committee no less than twice annually, pertaining to
implementation, barriers to implementation and other concerns
relating to staffing plans.
(6) Develop and implement a plan of action with the
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assistance of professional nurses providing direct patient
care and other appropriate staff, if there is evidence of
noncompliance with the staffing plan and the noncompliance
with the staffing plan negatively impacts patients and
professional nurses.
(7) Establish a process by which immediate concerns
about nurse staffing can be reported and addressed within
nursing and inform the professional nurse staff of the
process.
(8) Develop mechanisms by which professional nursing
staff can raise concerns and make recommendations about the
staffing plans either through the existing staffing 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, for internal purposes, to
the chief executive officer, the staffing committee and the
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) Make available to all patients information on how
to make a request for the staffing plan, including the
appropriate person, office or department that may be
contacted to review or obtain a copy of the plan.
(13) In the event of an unforeseeable emergent
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circumstance, the hospital administration shall notify the
chairperson within 24 hours that immediate efforts were made
to meet the staffing plan.
(14) Comply with act of December 12, 1986 (P.L.1559,
No.169), known as the Whistleblower Law, and section
307(b) (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.
(15) Comply with the act of October 9, 2008 (P.L.1376,
No.102), known as the Prohibition of Excessive Overtime in
Health Care Act.
Section 807-A. Protections for professional nurses.
(a) Refusal of assignment.--A professional nurse who refuses
an assignment that is in conflict with a hospital's staffing
plan shall not be deemed to have engaged in negligent action or
patient abandonment or to be in violation of professional
nursing laws or regulations.
(b) Retaliation prohibited.--A hospital may not retaliate
against a professional nurse for serving on a staffing committee
or participating in the development, approval or review of a
staffing plan.
Section 808-A . Duties and responsibilities of department.
(a) Form.--The department shall develop a form to be
completed by an individual designated by the department to
inspect a hospital under section 806.4.
(b) Penalty.--The department may impose an administrative
penalty of $1,000 per day upon a hospital not in compliance with
this chapter.
(c) Regulations.--The department shall promulgate
regulations necessary to implement the provisions of this
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chapter.
Section 809-A . Safe Staffing Penalty Account.
(a) Establishment.--The Safe Staffing Penalty Account is
established as a restricted account in the General Fund.
(b) Deposit.--The department shall deposit money collected
from the penalty imposed under section 808-A(b) into the
account.
(c) Use.--Money in the account is appropriated on a
continuing basis to the department for use in the performance of
its duties.
Section 810-A . Confidentiality.
The following shall apply:
(1) The department shall ensure confidentiality of the
reports made under this chapter in accordance with the act of
June 10, 2009 (P.L.1, No.1), known as the Preventable Serious
Adverse Events Act.
(2) The department shall ensure the confidentiality of
the annual report required by section 806-A(11) . The annual
report shall not be included in the discovery process of any
subsequent lawsuits filed against a hospital.
Section 2. This act shall take effect in 180 days.
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