PRINTER'S NO. 334
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
336
Session of
2017
INTRODUCED BY FONTANA, LEACH, SABATINA, COSTA, BLAKE,
LANGERHOLC, HAYWOOD, BREWSTER, HUGHES AND BROWNE,
FEBRUARY 15, 2017
REFERRED TO HEALTH AND HUMAN SERVICES, FEBRUARY 15, 2017
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.
TABLE OF CONTENTS
Chapter 1. General Provisions
Section 101. Short title.
Section 102. Purpose of act.
Section 103. Definitions.
Chapter 2. Nursing Staff Reporting
Section 201. Nursing staff report.
Section 202. Posting.
Section 203. Submission of report to department.
Section 204. Retention of records.
Section 205. Exclusion.
Section 206. Divisions and subsidiaries.
Section 207. Whistleblower protection.
Section 208. Forms.
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Section 209. Quarterly reports.
Section 210. Monitoring.
Section 211. Compliance by hospitals.
Chapter 3. Miscellaneous Provisions
Section 301. Effective date.
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 of act.
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) Decades of nursing research demonstrate that unsafe
nurse staffing practices have resulted in adverse patient
outcomes.
(3) Information on nurse staffing levels, such as nurse-
to-patient ratios, 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
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providing direct patient care during any portion of the nurse's
shift. The term includes a nurse's 15-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 concentrate on
only one facet of a patient's care and who interact 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
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.
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"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.
"Retaliate." To discipline, discharge, suspend, harass, deny
employment or promotion, lay off or take any other adverse
action.
"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 12-hour periods,
consisting of day and night. The emergency room and the
postanesthesia care unit, in those hospitals where the
postanesthesia care unit is open 24 hours per day, shall report
a 24-hour shift.
"Sitters." Companions to patients at high risk of falls,
suicide or other conditions.
"Turnover rate." The percentage of direct care nursing staff
that leaves a unit, either voluntarily or involuntarily.
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
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information:
(1) The number of each of the following types of staff
providing direct patient care:
(i) Registered nurses.
(ii) Licensed practical nurses.
(iii) Certified nursing assistants.
(iv) Unlicensed personnel.
(2) The ratio 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 registered respiratory therapist or the
direct care nursing staff of the unit.
(6) Percentage of contractual 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 filed with the
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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 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, 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 classified as licensed practical nurses. Staffing hours
for unlicensed mental health technicians or other unlicensed
personnel will be included as unlicensed personnel hours.
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(6) Graduate nurses who participate in an internship
program shall not be included in determining the ratio of
patients to direct care nursing staff, except orientee or
graduate nurse hours shall be included when the graduate
nurse 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 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
patients shall be included in the daily report of the patient
care unit where the patient is receiving care.
(11) The staff ratio 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:
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(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 provided to any member of the public upon
request at no charge.
Section 205. Exclusion.
Outpatient units 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 the other entity.
Section 207. Whistleblower protection.
(a) General rule.--A hospital shall not penalize,
discriminate or retaliate in any manner against an employee with
respect to compensation or the terms, conditions or privileges
of employment who in good faith, individually or in conjunction
with another person, does any of the following, or intimidate,
threaten or punish an employee to prevent the employee from
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doing any of the following:
(1) Disclosing 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) Initiating, cooperating or otherwise participating
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 patient or the public.
(3) Objecting or refusing 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) Participating in a committee or peer review process
or filing 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 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
hospital manager of the activity, policy, practice or
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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 manager shall respond in writing to the employee
within seven days to acknowledge that the notice was
received. The manager shall provide written notice of any
action taken within a reasonable time of receiving the
employee's notice.
(3) The notice requirement under paragraph (1) shall not
apply if the employee is reasonably certain that the
activity, policy or practice:
(i) is known by one or more hospital managers that
have had the opportunity to correct the problem and have
not done so;
(ii) involves the commission of a crime;
(iii) places patient health or safety in severe or
immediate danger; or
(iv) is reported by the employee in a survey,
investigation or other activity of a regulatory agency.
Section 208. Forms.
The department shall develop standardized reporting forms to
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 a three-month period as follows:
(1) Ratios 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
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utilized.
(4) Daily numbers of direct care nursing staff and
patients in the emergency department.
(5) Daily number of registered respiratory care
therapists.
(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.
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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