HOUSE OF REPRESENTATIVES

H.B. NO.

1214

TWENTY-SIXTH LEGISLATURE, 2011

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to registered nurses.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.   The legislature finds that research evidence demonstrates that registered nurses play a critical role in patient safety and quality of care.  The shortage of nurses available to provide care in acute care hospitals has necessitated multiple strategies to generate more nurses and improve the recruitment and retention of nurses in hospitals.

     Evidence-based nurse staffing that can help ensure quality and safe patient care while increasing nurse satisfaction in the work environment is essential to solving an urgent public health issue in Hawaii.  Hospitals and nursing organizations recognize a mutual interest in patient safety initiatives that create a healthy environment for nurses and safe care for patients.

     In order to protect patients and to support greater retention of registered nurses, and to promote evidence-based nurse staffing, the legislature intends to establish a mechanism whereby direct care nurses and hospital management shall participate in a joint process regarding decisions about nurse staffing.

     SECTION 2.  The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

registered nurse staffing levels

     §   -1  Definitions.  As used in this chapter unless the context clearly requires otherwise, the following terms shall have the meanings ascribed to them:

     "Acute care hospital" means a short-term hospital that has facilities, medical staff and other personnel to provide diagnosis, care and treatment of a wide range of acute conditions, including disease, trauma or recovery from surgery.  Acute care is usually given in a hospital by specialized personnel using complex and sophisticated technical equipment and materials, and it may involve intensive or emergency care.

     "Critical access hospital" means a rural limited service hospital that has been converted to a special designation as a critical access hospital under the medicare rural hospital flexibility grant program.  A critical access hospital consists of no more than fifteen acute beds and ten swing beds, if desired.  The total compliment of acute care beds and swing beds shall not exceed twenty-five.

     "Hospital" includes acute care hospitals, state hospitals, critical access hospitals, and psychiatric hospitals.

     "Intensity" means the level of patient need for nursing care.

     "Nurse":

     (1)  Means a person licensed under chapter 457 to practice nursing;

     (2)  Does not include licensed practical nurses or certified nursing assistants.

     "Nurse staffing committee" means a committee established by a hospital under this chapter.

     "Patient care unit" means any unit or area of the hospital that provides patient care by registered nurses.

     "Skill mix" means the number and relative percentages of registered nurses, licensed practical nurses, and unlicensed assistive personnel among the total number of nursing personnel.

     §   -2  Nurse staffing committee.  (a)  By September 1, 2011, each acute care hospital and all critical access hospitals shall establish a nurse staffing committee either by creating a new committee or assigning the functions of a nurse staffing committee to an existing committee to develop a documented staffing plan as required pursuant to this chapter.

     At least sixty per cent of the nurse staffing committee shall be registered nurses currently providing direct patient care and forty per cent of the members shall be determined by the hospital administration.  The selection of the registered nurses providing direct patient care on the staffing committee shall be according to the collective bargaining agreement, if applicable, or through selection by their peers.

     Participation in the nurse staffing committee by a registered nurse shall be on scheduled work time and compensated at the appropriate rate of pay.  Nurse staffing committee members shall be relieved of all other work duties during meetings of the committee.

     (b)  Primary responsibilities of the nurse staffing committee shall include the development and oversight of annual patient care unit and shift-based nurse staffing plan, based on the needs of patients, to be used as a primary component of the staffing budget.  Factors to be considered in the development of the plan shall include:

     (1)  Census, including the total number of patients on the unit on each shift and activity such as patient discharges, admissions, and transfers;

     (2)  Level of intensity of all patients and nature of care to be delivered on each shift;

     (3)  Skill mix and classification of registered nurses required in each unit in the health care facility, which shall take into account the level of experience of the clinical and nonclinical support staff with whom the nurses collaborate, supervise, or otherwise delegate assignments;

     (4)  The need for specialized or intensive equipment or technology;

     (5)  The size and geography of each unit, including placement of patient rooms, treatment areas, nursing stations, medication preparation rooms, and equipment;

     (6)  Staffing guidelines adopted or published by national nursing professional associations, specialty nursing organizations, and other health professional organizations;

     (7)  Semi-annual review of the staffing plan against patient need and known evidence-based staffing information, including the nursing sensitive quality indicators collected by the hospital;

     (8)  Review, assessment, and response to staffing concerns presented to the committee; and

     (9)  Hospital finances and resources.

     (c)  The staffing plan shall not diminish other standards contained in state or federal law or rules, or the terms of an applicable collective bargaining agreement, if any, between the hospital and the exclusive representative of the registered nursing staff.

     (d)  The committee shall produce the hospital's annual nurse staffing plan.  If the staffing plan is not adopted by the hospital, the hospital administration shall provide a written explanation of the reasons for nonadoption to the committee.

     (e)  Each hospital shall post, in a public area on each patient care unit, the nurse staffing plan and the nurse staffing schedule for that shift on that unit, as well as the relevant clinical staffing for that shift.  The staffing plan and current staffing levels shall also be made available to patients and visitors upon request.

     (f)  A hospital shall not retaliate or engage in any form of intimidation of:

     (1)  An employee for performing any duties or responsibilities in connection with the nurse staffing committee; or

     (2)  An employee, patient, or other individual who notifies the nurse staffing committee or the hospital administration of their concerns on nurse staffing.

     (g)  This section is not intended to create unreasonable burdens on critical access hospitals under 42 U.S.C. section 1395.  Critical access hospitals may develop flexible approaches to accomplish the requirements of this section that may include having nurse staffing committees work by telephone, video conferencing, or electronic mail.

     §   -3  Certificates of need.  As a condition of retaining a certificate of need, an acute care or critical access hospital shall make available to the department of health a documented nurse staffing plan and a written certification that the documented staffing plan is adequate to meet the needs of patients in the hospital.  The documented staffing plan shall include, without limitation:

     (1)  A detailed written plan setting forth the number, skill mix, and classification of registered nurses in each hospital unit, which shall take into account the experience of the clinical and nonclinical support staff with whom the nurses supervise, collaborate, or otherwise delegate assignments;

     (2)  A description of the types of patients who are treated in each unit, including, without limitation, discharges, transfers and admissions;

     (3)  A description of the size and geography of each unit;

     (4)  A description of any specialized equipment and technology available for each unit; and

     (5)  Any foreseeable changes in the size or function of each patient care unit."

     SECTION 3.  This Act shall take effect upon its approval.

 

INTRODUCED BY:

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Report Title:

Registered Nurses; Hospitals

 

Description:

Requires acute care and critical access hospitals to provide DOH with a documented nurse staffing plan in order to retain their certificates of need and to establish internal nurse staffing committees.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.