The New York State Senate

                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1532

                       2017-2018 Regular Sessions

                          I N  A S S E M B L Y

                            January 12, 2017
                               ___________

Introduced by M. of A. GUNTHER, GOTTFRIED, ROSENTHAL, BRINDISI, BRONSON,
  COLTON,  BENEDETTO,  JAFFEE, MAGNARELLI, M. G. MILLER, WEPRIN, RIVERA,
  RYAN, SKARTADOS, SEPULVEDA, AUBRY, OTIS, SKOUFIS, STECK, MAYER, SANTA-
  BARBARA, ZEBROWSKI, MOSLEY, ORTIZ, TITUS, ABINANTI, BARRON, SEAWRIGHT,
  WALKER,  BICHOTTE,  RICHARDSON,  HYNDMAN,  PEOPLES-STOKES,   PICHARDO,
  JOYNER,  JEAN-PIERRE,  LENTOL,  ROZIC, HARRIS, KIM, HEVESI, O'DONNELL,
  DILAN, DAVILA, HUNTER, BLAKE, KAVANAGH, WILLIAMS, BRABENEC,  MONTESANO
  --  Multi-Sponsored  by  -- M. of A. ABBATE, ARROYO, BUCHWALD, BUTLER,
  CAHILL, COOK, CRESPO, CUSICK, CYMBROWITZ, DenDEKKER, DINOWITZ,  ENGLE-
  BRIGHT,  FAHY,  FARRELL,  GALEF,  GLICK,  GRAF,  HOOPER, JENNE, JOHNS,
  KEARNS,  LIFTON,  LUPARDO,  LUPINACCI,  MAGEE,  McDONOUGH,   McKEVITT,
  PAULIN,  PERRY, PRETLOW, RA, RAMOS, SALADINO, SIMON, SIMOTAS, SOLAGES,
  THIELE, TITONE, WOERNER -- read once and referred to the Committee  on
  Health

AN ACT to amend the public health law, in relation to enacting the "safe
  staffing for quality care act"

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Short title. This act shall be known and may  be  cited  as
the "safe staffing for quality care act".
  §  2.  Paragraphs  (a) and (b) of subdivision 2 of section 2805 of the
public health law, paragraph (a) as amended by chapter 923 of  the  laws
of  1973  and paragraph (b) as added by chapter 795 of the laws of 1965,
are amended to read as follows:
  (a) Application for an operating certificate for a hospital  shall  be
made  upon  forms  prescribed  by  the department. The application shall
[contain] INCLUDE the name of the hospital, the kind or kinds of  hospi-
tal service to be provided, the location and physical description of the
institution,  A  DOCUMENTED STAFFING PLAN, AS DEFINED IN SECTION TWENTY-
EIGHT HUNDRED TWENTY-EIGHT OF THIS ARTICLE, and such  other  information
as the department may require.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD02902-03-7

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  (b)  An  operating  certificate  shall not be issued by the department
unless it finds that  the  premises,  equipment,  personnel,  DOCUMENTED
STAFFING  PLAN, rules and by-laws, standards of medical care, and hospi-
tal service are fit and adequate and that the hospital will be  operated
in  the manner required by this article and rules and regulations there-
under.
  § 3. The public health law is amended  by  adding  nine  new  sections
2827,  2828,  2829,  2830,  2831,  2832,  2833, 2834 and 2835 to read as
follows:
  § 2827. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL  OF
THE FOLLOWING:
  1.  HEALTH  CARE  SERVICES ARE BECOMING COMPLEX AND IT IS INCREASINGLY
DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES;
  2. THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE  STAFF-
ING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES;
  3.  TO  ENSURE  THE  ADEQUATE  PROTECTION  OF  PATIENTS IN HEALTH CARE
SETTINGS, IT IS ESSENTIAL THAT QUALIFIED  REGISTERED  NURSES  AND  OTHER
LICENSED  NURSES  BE  ACCESSIBLE  AND  AVAILABLE  TO  MEET  THE NEEDS OF
PATIENTS; AND
  4. THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING  SHOULD
BE  BASED  ON  THE  PATIENT'S  CARE  NEEDS,  THE  SEVERITY OF CONDITION,
SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES.
  § 2828. SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS  AND  PHRASES,
AS  USED  IN  THIS ARTICLE, SHALL HAVE THE FOLLOWING MEANINGS UNLESS THE
CONTEXT OTHERWISE PLAINLY REQUIRES:
  1. "ACUTE CARE FACILITY" SHALL MEAN A HOSPITAL OTHER THAN  A  RESIDEN-
TIAL  HEALTH  CARE  FACILITY  AND  SHALL  ALSO INCLUDE ANY FACILITY THAT
PROVIDES HEALTH CARE SERVICES PURSUANT TO THE MENTAL HYGIENE LAW,  ARTI-
CLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION LAW IF SUCH FACIL-
ITY  IS OPERATED BY THE STATE OR A POLITICAL SUBDIVISION OF THE STATE OR
A PUBLIC AUTHORITY OR PUBLIC BENEFIT CORPORATION.
  2. "ACUITY SYSTEM" SHALL MEAN AN  ESTABLISHED  MEASUREMENT  INSTRUMENT
WHICH  (A)  PREDICTS  NURSING  CARE REQUIREMENTS FOR INDIVIDUAL PATIENTS
BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND
TECHNOLOGY,  INTENSITY  OF  NURSING  INTERVENTIONS  REQUIRED,  AND   THE
COMPLEXITY  OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND
EVALUATE THE PATIENT'S NURSING CARE PLAN;  (B)  DETAILS  THE  AMOUNT  OF
NURSING  CARE  NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND IN SKILL
MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN
A NURSING DEPARTMENT OR UNIT; AND (C) IS STATED IN  TERMS  THAT  READILY
CAN  BE  USED  AND  UNDERSTOOD  BY DIRECT-CARE NURSES. THE ACUITY SYSTEM
SHALL TAKE INTO CONSIDERATION THE PATIENT  CARE  SERVICES  PROVIDED  NOT
ONLY  BY  REGISTERED  PROFESSIONAL NURSES BUT ALSO BY LICENSED PRACTICAL
NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL.
  3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE
STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT
NURSING CARE REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF  AN  ACUITY
SYSTEM.
  4.  "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN ANY
NURSE WHO HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY  OUT  MEDICAL
REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS.
  5.  "DOCUMENTED  STAFFING  PLAN"  SHALL  MEAN  A DETAILED WRITTEN PLAN
SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURS-
ES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN AN ACUTE CARE FACILITY
FOR A GIVEN YEAR, BASED  ON  REASONABLE  PROJECTIONS  DERIVED  FROM  THE
PATIENT  CENSUS  AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT OR UNIT

A. 1532                             3

DURING THE PRIOR YEAR, THE DEPARTMENT OR UNIT SIZE  AND  GEOGRAPHY,  THE
NATURE OF SERVICES PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR
UNIT SIZE OR FUNCTION DURING THE CURRENT YEAR.
  6.  "NURSE"  SHALL  MEAN  A  REGISTERED PROFESSIONAL NURSE OR LICENSED
PRACTICAL NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE  OF
THE EDUCATION LAW.
  7.  "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE DEFINITION
OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF
THE EDUCATION LAW, OR OTHERWISE ENCOMPASSED WITH THE  RECOGNIZED  STAND-
ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN-
NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY.
  8.  "SAFE  STAFFING  REQUIREMENTS"  SHALL  MEAN THE PROVISIONS OF THIS
SECTION AND SECTIONS  TWENTY-EIGHT  HUNDRED  TWENTY-SEVEN,  TWENTY-EIGHT
HUNDRED  TWENTY-NINE,  TWENTY-EIGHT HUNDRED THIRTY, TWENTY-EIGHT HUNDRED
THIRTY-ONE, TWENTY-EIGHT HUNDRED THIRTY-TWO, TWENTY-EIGHT HUNDRED  THIR-
TY-THREE,  TWENTY-EIGHT  HUNDRED  THIRTY-FOUR  AND  TWENTY-EIGHT HUNDRED
THIRTY-FIVE OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSU-
ANT THERETO.
  9. "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY  AND
EXPERIENCE AMONG DIRECT-CARE NURSES.
  10.  "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO PATIENT
RATIO WITHIN A NURSING DEPARTMENT OR UNIT.
  11. "UNIT" SHALL MEAN A PATIENT CARE  COMPONENT,  AS  DEFINED  BY  THE
DEPARTMENT, WITHIN AN ACUTE CARE FACILITY.
  12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT
A  NURSE  OR  OTHER PERSON LICENSED, CERTIFIED OR REGISTERED UNDER TITLE
EIGHT OF THE EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY  IS  TO  CARRY
OUT  PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT ASSISTANCE
IN THE DELIVERY OF PATIENT CARE.
  § 2829. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE  COMMISSIONER
SHALL:
  1.  APPOINT  AN  ACUTE  CARE  FACILITY  COUNCIL CONSISTING OF THIRTEEN
MEMBERS. NO LESS THAN SEVEN MEMBERS  SHALL  BE  REGISTERED  PROFESSIONAL
NURSES,  THREE  OF WHOM SHALL BE DIRECT CARE REGISTERED NURSES, THREE OF
WHOM SHALL BE NURSE MANAGERS AND ONE OF WHOM SHALL BE A  NURSE  ADMINIS-
TRATOR.  NO  LESS  THAN  TWO  MEMBERS OF THE ACUTE CARE FACILITY COUNCIL
SHALL BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE  BARGAIN-
ING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO
REPRESENTATIVES  OF ACUTE CARE FACILITIES, ONE REPRESENTATIVE OF A NURS-
ING PROFESSIONAL ASSOCIATION, AND ONE REPRESENTATIVE OF A RECOGNIZED  OR
CERTIFIED  BARGAINING  AGENT  OF NURSES. THE ACUTE CARE FACILITY COUNCIL
SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS, INCLUD-
ING REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING  REQUIREMENTS  AND
NON-NURSING  DIRECT-CARE  STAFF TO PATIENT RATIOS THAT ARE NOT SPECIFIED
IN THIS ARTICLE; THE EFFICACY OF ACUITY SYSTEMS SUBMITTED  FOR  APPROVAL
BY THE COMMISSIONER; THE DEVELOPMENT OF AN ASSESSMENT TOOL USED TO EVAL-
UATE THE EFFICACY OF ACUITY SYSTEMS; AND REVIEW AND MAKE RECOMMENDATIONS
ON  APPROVAL  OF  STAFFING  PLANS  PRIOR TO THE GRANTING OF AN OPERATING
CERTIFICATE BY THE DEPARTMENT.
  2. PROMULGATE, AFTER CONSULTATION WITH THE ACUTE CARE  FACILITY  COUN-
CIL,  THE  RULES AND REGULATIONS NECESSARY TO CARRY OUT THE PURPOSES AND
PROVISIONS OF THE  SAFE  STAFFING  REQUIREMENTS,  INCLUDING  REGULATIONS
DEFINING  TERMS,  SETTING  FORTH  DIRECT-CARE  NURSE  TO PATIENT RATIOS,
SETTING FORTH  NON-NURSING  DIRECT-CARE  STAFF  TO  PATIENT  RATIOS  AND
PRESCRIBING  THE PROCESS FOR APPROVING FACILITY SPECIFIC ACUITY SYSTEMS;
AND

A. 1532                             4

  3. ASSURE THAT  THE  PROVISIONS  OF  SAFE  STAFFING  REQUIREMENTS  ARE
ENFORCED,  INCLUDING  THE  ISSUANCE  OF  REGULATIONS  WHICH AT A MINIMUM
PROVIDE FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE  FAILURE
TO  COMPLY  WITH  SUCH  REQUIREMENTS  AND  PUBLIC  ACCESS TO INFORMATION
REGARDING  REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS
PURSUANT TO SUCH REQUIREMENTS.
  § 2830. STAFFING REQUIREMENTS. 1. STAFFING  REQUIREMENTS.  EACH  ACUTE
CARE  FACILITY SHALL ENSURE THAT IT IS STAFFED IN A MANNER THAT PROVIDES
SUFFICIENT, APPROPRIATELY QUALIFIED DIRECT-CARE NURSES IN  EACH  DEPART-
MENT  OR  UNIT  WITHIN SUCH FACILITY IN ORDER TO MEET THE INDIVIDUALIZED
CARE NEEDS OF THE PATIENTS THEREIN. AT A  MINIMUM,  EACH  SUCH  FACILITY
SHALL  MEET  THE  REQUIREMENTS  OF  SUBDIVISIONS  TWO  AND THREE OF THIS
SECTION.
  2. STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING  CERTIF-
ICATE  TO  ANY ACUTE CARE FACILITY UNLESS SUCH FACILITY ANNUALLY SUBMITS
TO THE DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN CERTIFICATION
THAT THE SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE  ADEQUATE  AND
APPROPRIATE DELIVERY OF HEALTH CARE SERVICES TO PATIENTS FOR THE ENSUING
YEAR. THE DOCUMENTED STAFFING PLAN SHALL:
  (A)  MEET  THE  MINIMUM REQUIREMENTS SET FORTH IN SUBDIVISION THREE OF
THIS SECTION;
  (B) BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY  OTHER
LAWS, RULES OR REGULATIONS;
  (C)  EMPLOY  AND IDENTIFY AN ACUITY SYSTEM FOR ADDRESSING FLUCTUATIONS
IN ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS  REQUIRING
INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE PLAN;
  (D)  FACTOR  IN  OTHER UNIT OR DEPARTMENT ACTIVITY SUCH AS DISCHARGES,
TRANSFERS AND ADMISSIONS, STAFF  BREAKS,  MEALS,  ROUTINE  AND  EXPECTED
ABSENCES  FROM  THE  UNIT  AND ADMINISTRATIVE AND SUPPORT TASKS THAT ARE
EXPECTED TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT  NURSING
CARE;
  (E)  INCLUDE  A  PLAN  TO  MEET NECESSARY STAFFING LEVELS AND SERVICES
PROVIDED BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE  NEEDS
PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE
STAFFING  PLAN  SHALL  NOT INCORPORATE OR ASSUME THAT NURSING CARE FUNC-
TIONS REQUIRED BY LAWS, RULES OR REGULATIONS, OR ACCEPTED  STANDARDS  OF
PRACTICE  TO  BE  PERFORMED BY A REGISTERED PROFESSIONAL NURSE ARE TO BE
PERFORMED BY OTHER PERSONNEL;
  (F) IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL  STAFFING
ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT;
  (G)  INCLUDE  A WRITTEN ASSESSMENT OF THE ACCURACY OF THE PRIOR YEAR'S
STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS;
  (H) IDENTIFY EACH NURSE STAFF CLASSIFICATION REFERENCED IN  SUCH  PLAN
TOGETHER  WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR EACH
SUCH CLASSIFICATION; AND
  (I) BE DEVELOPED IN CONSULTATION WITH A MAJORITY  OF  THE  DIRECT-CARE
NURSES  WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE REPRES-
ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING
REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER
SUPPORTIVE AND ASSISTIVE STAFF.
  3. MINIMUM STAFFING REQUIREMENTS. (A)  THE  DOCUMENTED  STAFFING  PLAN
SHALL  INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PA-
TIENT RATIOS:
  (I) ONE NURSE TO ONE PATIENT:  OPERATING  ROOM  AND  TRAUMA  EMERGENCY
UNITS  AND  MATERNAL/CHILD  CARE  UNITS FOR THE SECOND OR THIRD STAGE OF
LABOR;

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  (II) ONE NURSE TO TWO PATIENTS:   MATERNAL/CHILD CARE  UNITS  FOR  THE
FIRST  STAGE  OF  LABOR, AND ALL CRITICAL CARE AREAS INCLUDING EMERGENCY
CRITICAL CARE AND ALL INTENSIVE CARE UNITS AND POSTANESTHESIA UNITS;
  (III)  ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA-
TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME-
DIATE CARE NURSERY UNITS;
  (IV) ONE NURSE TO THREE PATIENTS:    POSTPARTUM  MOTHER/BABY  COUPLETS
(MAXIMUM SIX PATIENTS PER NURSE);
  (V)  ONE  NURSE  TO  FOUR  PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS,
POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHI-
ATRIC UNITS;
  (VI) ONE NURSE TO FIVE PATIENTS:  REHABILITATION  UNITS  AND  SUBACUTE
PATIENTS; AND
  (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS.
  FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED
TO,  PSYCHIATRIC  UNITS,  AND ACUTE CARE FACILITIES OPERATED PURSUANT TO
THE MENTAL HYGIENE LAW OR  THE  CORRECTION  LAW,  THE  DEPARTMENT  SHALL
ESTABLISH  BY  REGULATION  THE  APPROPRIATE DIRECT-CARE NURSE-TO-PATIENT
RATIO.
  (B) THE NURSE-TO-PATIENT RATIOS SET FORTH IN  PARAGRAPH  (A)  OF  THIS
SUBDIVISION  SHALL  REFLECT  THE  MAXIMUM NUMBER OF PATIENTS THAT MAY BE
ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT AT ANY ONE TIME.
  (C) THERE SHALL BE NO AVERAGING OF THE  NUMBER  OF  PATIENTS  AND  THE
TOTAL  NUMBER  OF  NURSES  ON THE UNIT DURING ANY ONE SHIFT NOR OVER ANY
PERIOD OF TIME.
  (D) THE COMMISSIONER, IN CONSULTATION WITH  THE  ACUTE  CARE  FACILITY
COUNCIL,  SHALL  ESTABLISH  REGULATIONS PROVIDING FOR THE MAINTENANCE OF
MINIMUM NURSE-TO-PATIENT RATIOS, AS SET FORTH IN THIS SECTION, INCLUDING
DURING ROUTINE OR EXPECTED ABSENCES FROM THE  UNIT,  SUCH  AS  MEALS  OR
BREAKS.
  4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC-
TICAL  NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY PATIENTS
ASSIGNED TO THE LICENSED PRACTICAL  NURSE  SHALL  ALSO  BE  INCLUDED  IN
CALCULATING  THE  NUMBER  OF PATIENTS ASSIGNED TO ANY REGISTERED PROFES-
SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC-
TICE TO SUPERVISE OR OVERSEE THE DIRECT-NURSING  CARE  PROVIDED  BY  THE
LICENSED PRACTICAL NURSE.
  5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURS-
ING  CARE  FUNCTIONS  REQUIRED  BY SECTION SIXTY-NINE HUNDRED TWO OF THE
EDUCATION LAW OR ACCEPTED STANDARDS OF PRACTICE TO  BE  PERFORMED  BY  A
REGISTERED  PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED PRACTI-
CAL NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE  FUNC-
TIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR
ACCEPTED  STANDARDS  OF PRACTICE TO BE PERFORMED BY A LICENSED PRACTICAL
NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL.
  6. ADJUSTMENTS BY FACILITY.   THE  MINIMUM  STAFFING  REQUIREMENT  AND
NURSE-TO-PATIENT  RATIO  SET  FORTH IN THIS SECTION SHALL BE ADJUSTED BY
THE ACUTE CARE FACILITY AS NECESSARY TO REFLECT THE NEED FOR  ADDITIONAL
DIRECT-CARE  NURSES.    ADDITIONAL STAFF SHALL BE ASSIGNED IN ACCORDANCE
WITH THE APPROVED, FACILITY-SPECIFIC PATIENT ACUITY SYSTEM FOR DETERMIN-
ING NURSING CARE REQUIREMENTS, INCLUDING THE SEVERITY  OF  THE  ILLNESS,
THE  NEED  FOR  SPECIALIZED  EQUIPMENT AND TECHNOLOGY, THE COMPLEXITY OF
CLINICAL JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND EVALUATE  THE  PATIENT
CARE  PLAN  AND  THE  ABILITY  FOR  SELF-CARE,  AND THE LICENSURE OF THE
PERSONNEL REQUIRED FOR CARE.

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  7. COMMISSIONER REGULATIONS.    THE  COMMISSIONER  MAY  BY  REGULATION
REQUIRE  A  DOCUMENTED  STAFFING  PLAN  TO  HAVE HIGHER NURSE-TO-PATIENT
RATIOS THAN THOSE SET FORTH IN THIS SECTION.
  8.   NOTHING CONTAINED IN THIS SECTION SHALL SUPERSEDE OR DIMINISH THE
TERMS OF A COLLECTIVE BARGAINING AGREEMENT THAT  PROVIDES  FOR  STAFFING
RATIOS THAT EXCEED THE RATIOS ESTABLISHED UNDER THIS SECTION.
  §  2831.  COMPLIANCE  WITH  STAFFING PLAN AND RECORDKEEPING. 1.   EACH
ACUTE CARE FACILITY SHALL AT ALL TIMES  STAFF  IN  ACCORDANCE  WITH  ITS
DOCUMENTED STAFFING PLAN AND THE STAFFING STANDARDS SET FORTH IN SECTION
TWENTY-EIGHT  HUNDRED  THIRTY  OF  THIS ARTICLE; PROVIDED, HOWEVER, THAT
NOTHING IN THIS SECTION SHALL BE DEEMED TO PRECLUDE  ANY  SUCH  FACILITY
FROM  IMPLEMENTING  HIGHER DIRECT-CARE NURSE-TO-PATIENT STAFFING LEVELS,
NOR SHALL THE  REQUIREMENTS  SET  FORTH  IN  SUCH  SECTION  TWENTY-EIGHT
HUNDRED  THIRTY  OF  THIS  ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY
HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, REGULATION OR CONTRACT.
  2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM  STAFFING  REQUIREMENTS
STANDARDS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED THIRTY OF THIS ARTI-
CLE,  NO  NURSE  SHALL  BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT
RATIO COUNT IN A NURSING UNIT OR A CLINICAL AREA WITHIN  AN  ACUTE  CARE
FACILITY  UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTI-
CLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION  LAW,  HAS  RECEIVED  PRIOR
ORIENTATION  IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURS-
ING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND  HAS  DEMON-
STRATED  CURRENT  COMPETENCE  IN PROVIDING CARE IN THAT UNIT OR CLINICAL
AREA. ACUTE CARE FACILITIES  THAT  UTILIZE  TEMPORARY  NURSING  AGENCIES
SHALL  HAVE  AND  ADHERE  TO  A WRITTEN PROCEDURE TO ORIENT AND EVALUATE
PERSONNEL FROM SUCH SOURCES TO ENSURE ADEQUATE ORIENTATION AND COMPETEN-
CY PRIOR TO INCLUSION IN THE NURSE-TO-PATIENT RATIO.  IN THE EVENT OF AN
EMERGENCY STAFFING SITUATION IN WHICH INSUFFICIENT STAFFING MAY LEAD  TO
UNSAFE  PATIENT  CARE, NURSES MAY BE TEMPORARILY ASSIGNED TO A DIFFERENT
UNIT OR CLINICAL AREA, PROVIDED  THAT  SUCH  NURSES  SHALL  BE  ASSIGNED
PATIENTS  APPROPRIATE  TO THEIR SKILL AND COMPETENCY LEVEL. THE FACILITY
SHALL ESTABLISH A CONSISTENT  PLAN  FOR  ADDRESSING  EMERGENCY  STAFFING
SITUATIONS  AND  MONITOR  OUTCOMES.   EMERGENCIES ARE DEFINED AS NATURAL
DISASTERS, DECLARED EMERGENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS
NOT REASONABLY ANTICIPATED AND PLANNED FOR AND NOT  REGULARLY  OCCURRING
WITHIN THE FACILITY.
  3.  EACH  ACUTE  CARE  FACILITY  SHALL MAINTAIN ACCURATE DAILY RECORDS
SHOWING:
  (A) THE NUMBER OF PATIENTS ADMITTED,  RELEASED  AND  PRESENT  IN  EACH
NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY;
  (B)  THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH NURS-
ING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; AND
  (C) THE IDENTITY AND DUTY HOURS OF  EACH  DIRECT-CARE  NURSE  IN  EACH
NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY.
  4.  EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURS-
ING DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY,  INFECTION,  ACCIDENT,
INJURY AND MEDICAL ERRORS.
  5.  ALL  RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE
MAINTAINED FOR A PERIOD OF SEVEN YEARS.
  6. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION  SHALL  BE
MADE  AVAILABLE  UPON  REQUEST  TO  THE  DEPARTMENT  AND  TO THE PUBLIC;
PROVIDED, HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL  COMPLY
WITH  THE  APPLICABLE  PATIENT  PRIVACY LAWS, RULES AND REGULATIONS, AND
THAT IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE  IDENTITY
AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC.

A. 1532                             7

  §  2832. WORK ASSIGNMENT POLICY. 1. GENERAL.  EACH ACUTE CARE FACILITY
SHALL ADOPT, DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN
WORK ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS  TWO
AND  THREE  OF  THIS  SECTION, DETAILING THE CIRCUMSTANCES UNDER WHICH A
DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT.
  2.  MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT:
  (A) FOR WHICH THE NURSE IS NOT  PREPARED  BY  EDUCATION,  TRAINING  OR
EXPERIENCE  TO  SAFELY  FULFILL  THE  ASSIGNMENT WITHOUT COMPROMISING OR
JEOPARDIZING PATIENT SAFETY, THE NURSE'S  ABILITY  TO  MEET  FORESEEABLE
PATIENT NEEDS OR THE NURSE'S LICENSE; OR
  (B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS.
  3.  MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
CONTAIN PROCEDURES FOR THE FOLLOWING:
  (A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR
REGARDING THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING  RELIEVED
OF AN ASSIGNMENT OR CONTINUED DUTY;
  (B)  WHERE  FEASIBLE,  AN OPPORTUNITY FOR THE SUPERVISOR TO REVIEW THE
SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH-
ER TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT,  OR
TO  DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR CONTIN-
UED DUTY;
  (C) A PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT  TO  REFUSE
THE  ASSIGNMENT  OR  CONTINUED ON-DUTY STATUS WHEN THE SUPERVISOR DENIES
THE REQUEST TO BE RELIEVED IF:
  (I) THE SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A  REMEDY  OR
THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY,
  (II)  THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY AGENCY
WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND
  (III) THE EMPLOYEE IN GOOD FAITH BELIEVES THAT  THE  ASSIGNMENT  MEETS
CONDITIONS JUSTIFYING REFUSAL; AND
  (D)  RECOGNITION  THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT TO A
WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED,
BY REASON THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR  INCOMPETENT  ACTION,
PATIENT  ABANDONMENT,  OR OTHERWISE TO HAVE VIOLATED ANY LAW RELATING TO
NURSING.
  § 2833. PUBLIC DISCLOSURE OF STAFFING REQUIREMENTS. EVERY  ACUTE  CARE
FACILITY SHALL:
  1.  POST  IN  A  CONSPICUOUS  PLACE  READILY ACCESSIBLE TO THE GENERAL
PUBLIC A NOTICE PREPARED BY THE DEPARTMENT SETTING FORTH  A  SUMMARY  OF
THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT FACILITY TOGETHER WITH
INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE FACILITY'S STAFF-
ING PLAN AND ACTUAL STAFFING MAY BE OBTAINED;
  2.  UPON  REQUEST,  MAKE  COPIES OF THE DOCUMENTED STAFFING PLAN FILED
WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND
  3. UPON REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF  WITHIN  A
DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION:
  (A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT,
  (B)  DOCUMENTATION  OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED TO BE
PRESENT DURING THE SHIFT, BASED ON THE APPROVED ADOPTED  ACUITY  SYSTEM,
AND
  (C)  DOCUMENTATION  OF THE ACTUAL NUMBER OF DIRECT-CARE NURSES PRESENT
DURING THE SHIFT.
  § 2834. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL  NOT  DELE-
GATE  ITS  RESPONSIBILITIES  TO  ENFORCE  THE SAFE STAFFING REQUIREMENTS
PROMULGATED PURSUANT TO THIS ARTICLE.

A. 1532                             8

  § 2835. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT
HUNDRED THIRTY-TWO OF THIS  ARTICLE.    ANY  ACUTE  CARE  FACILITY  THAT
VIOLATES  THE  RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGN-
MENT POLICY UNDER SECTION TWENTY-EIGHT HUNDRED THIRTY-TWO OF THIS  ARTI-
CLE  MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A COURT
OF COMPETENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS  MAY  BE
APPROPRIATE  TO  EFFECTUATE  THE  PURPOSES OF THE SAFE STAFFING REQUIRE-
MENTS, INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION, LOST WAGES
AND BENEFITS, AND COMPENSATORY AND CONSEQUENTIAL DAMAGES RESULTING  FROM
THE  VIOLATION  TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED DAMAGES. THE
COURT IN SUCH ACTION SHALL, IN ADDITION TO ANY  JUDGMENT  AWARDED  TO  A
PREVAILING  PLAINTIFF,  AWARD  REASONABLE  ATTORNEYS'  FEES AND COSTS OF
ACTION TO BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO  INSTITUTE  A
PRIVATE  ACTION PURSUANT TO THIS SUBDIVISION SHALL NOT BE LIMITED BY ANY
OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
  § 4. Section 2801-a of the public health law is amended  by  adding  a
new subdivision 3-b to read as follows:
  3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNI-
TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH AND HEALTH
PLANNING  COUNCIL SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL
RULES, REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE  RELATIONS,
WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRAC-
TICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING
COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF
THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS.
  §  5. Section 2805 of the public health law is amended by adding a new
subdivision 3 to read as follows:
  3. IN DETERMINING WHETHER TO ISSUE OR RENEW AN  OPERATING  CERTIFICATE
TO  AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN ACCORD-
ANCE WITH  THIS  ARTICLE,  THE  COMMISSIONER  SHALL  CONSIDER  ANY  PAST
VIOLATIONS  OF  STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING
TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE  BARGAINING
OR  ANY  OTHER  LABOR RELATED PRACTICES, OBLIGATIONS OR IMPERATIVES. THE
PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL  WEIGHT
TO  VIOLATIONS  OF THE PROVISIONS OF THIS CHAPTER CONCERNING NURSE STAFF
AND SUPPORTIVE STAFF RATIOS.
  § 6. The public health law is amended by adding a new  section  2895-b
to read as follows:
  §  2895-B.  RESIDENTIAL HEALTH CARE FACILITY STAFFING LEVELS. 1. DEFI-
NITIONS. AS USED IN THIS SECTION, THE FOLLOWING  TERMS  SHALL  HAVE  THE
FOLLOWING MEANINGS:
  (A)  "CERTIFIED  NURSE AIDE" MEANS ANY PERSON INCLUDED IN THE RESIDEN-
TIAL HEALTH CARE FACILITY NURSE AIDE REGISTRY PURSUANT TO SECTION  TWEN-
TY-EIGHT HUNDRED THREE-J OF THIS CHAPTER.
  (B)  "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL IN
A PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD  IN
A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT
THAT TIME.
  2.  COMMISSIONER  AND RESIDENTIAL HEALTH CARE FACILITY COUNCIL; POWERS
AND DUTIES. THE COMMISSIONER SHALL: APPOINT A  RESIDENTIAL  HEALTH  CARE
FACILITY  COUNCIL  CONSISTING  OF  THIRTEEN  MEMBERS.  NO  LESS THAN TWO
MEMBERS SHALL BE DIRECT  CARE LICENSED PRACTICAL NURSES,  NO  LESS  THAN
TWO  MEMBERS SHALL BE DIRECT CARE CERTIFIED NURSE ASSISTANTS AND NO LESS
THAN  ONE MEMBER SHALL BE A DIRECT CARE REGISTERED  PROFESSIONAL  NURSE.
THE  COUNCIL  SHALL ALSO INCLUDE NO LESS THAN ONE REPRESENTATIVE EACH OF
RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF REGISTERED NURS-

A. 1532                             9

ES, OF NON-REGISTERED NURSE DIRECT CARE STAFF AND  A  REPRESENTATIVE  OF
NURSING  PROFESSIONAL  ASSOCIATIONS.  THE  COUNCIL SHALL ALSO INCLUDE NO
LESS THAN TWO REPRESENTATIVES OF RESIDENTIAL HEALTH CARE FACILITY OPERA-
TORS,  TWO  REPRESENTATIVES  OF  RESIDENTIAL  HEALTH CARE FACILITY NURSE
ADMINISTRATORS AND ONE  REPRESENTATIVE  OF  CONSUMERS.  THE  RESIDENTIAL
HEALTH CARE FACILITY COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVEL-
OPMENT  OF  REGULATIONS  RELATING  TO  THE STAFFING STANDARDS UNDER THIS
SECTION; AND MAY FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE LEGISLA-
TURE, THE PUBLIC AND  THE  COMMISSIONER  ANY  RECOMMENDATIONS  REGARDING
STAFFING LEVELS IN RESIDENTIAL HEALTH CARE FACILITIES.
  3. STAFFING STANDARDS.  (A) THE COMMISSIONER, IN CONSULTATION WITH THE
COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR RESIDEN-
TIAL  HEALTH  CARE  FACILITY  MINIMUM STAFFING LEVELS TO MEET APPLICABLE
STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAIN-
TAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BE-
ING OF EACH RESIDENT  OF  THE  FACILITY.  THE  COMMISSIONER  SHALL  ALSO
REQUIRE  BY REGULATION THAT EVERY RESIDENTIAL HEALTH CARE FACILITY MAIN-
TAIN RECORDS ON ITS STAFFING LEVELS,  REPORT  ON  SUCH  RECORDS  TO  THE
DEPARTMENT,  AND  MAKE  SUCH  RECORDS  AVAILABLE  FOR  INSPECTION BY THE
DEPARTMENT.
  (B) EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL:
  (I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND
  (II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF
SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES
TO ATTAIN OR MAINTAIN THE  HIGHEST  PRACTICABLE  PHYSICAL,  MENTAL,  AND
PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY.
  (C)  SUBJECT  TO  SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS
UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS  UNDER
SUBDIVISION FOUR OF THIS SECTION.
  (D)  IN  DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS
SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED  WHILE  PERFORMING  SERVICES
THAT  ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD
PREPARATION,  HOUSEKEEPING,  LAUNDRY,  MAINTENANCE  SERVICES,  OR  OTHER
ACTIVITIES THAT ARE NOT DIRECT NURSING CARE.
  4.    STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE
OF THIS SECTION, EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL MAINTAIN A
STAFFING RATIO EQUAL TO AT LEAST THE FOLLOWING:
  (A) 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED NURSE AIDE;
  (B) 1.3 HOURS OF CARE PER RESIDENT PER DAY  BY  A  LICENSED  PRACTICAL
NURSE OR A REGISTERED NURSE;
  (C) 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGISTERED NURSE; THE
MINIMUM  OF  0.75  HOURS  OF  CARE PER RESIDENT PROVIDED BY A REGISTERED
NURSE SHALL BE DIVIDED AMONG ALL SHIFTS TO ENSURE AN  APPROPRIATE  LEVEL
OF  REGISTERED  NURSE CARE TWENTY-FOUR HOURS PER DAY, SEVEN DAYS A WEEK,
TO MEET RESIDENT NEEDS; AND
  (D) RESIDENTIAL HEALTH CARE FACILITIES THAT CARE FOR SUBACUTE PATIENTS
SHALL MAINTAIN AT A MINIMUM, THE FOLLOWING DIRECT-CARE  NURSE-TO-PATIENT
RATIO: ONE NURSE TO FIVE PATIENTS.
  5.    ANY RESIDENTIAL HEALTH CARE FACILITY THAT VIOLATES THE RIGHTS OF
AN EMPLOYEE PURSUANT TO AN ADOPTED WORK  ASSIGNMENT  POLICY  UNDER  THIS
SECTION  MAY  BE  HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A
COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR  EQUITABLE  RELIEF  AS
MAY  BE  APPROPRIATE  TO  EFFECTUATE  THE  PURPOSES OF THE SAFE STAFFING
REQUIREMENTS, INCLUDING BUT NOT  LIMITED  TO  REINSTATEMENT,  PROMOTION,
LOST  WAGES  AND  BENEFITS,  AND  COMPENSATORY AND CONSEQUENTIAL DAMAGES
RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED

A. 1532                            10

DAMAGES. THE COURT IN SUCH ACTION SHALL, IN  ADDITION  TO  ANY  JUDGMENT
AWARDED  TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND
COSTS OF ACTION TO BE PAID BY THE  DEFENDANT.  AN  EMPLOYEE'S  RIGHT  TO
INSTITUTE  A  PRIVATE  ACTION  PURSUANT TO THIS SUBDIVISION SHALL NOT BE
LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
  6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A RESIDENTIAL HEALTH CARE
FACILITY SHALL POST INFORMATION REGARDING NURSE STAFFING THAT THE FACIL-
ITY IS REQUIRED TO MAKE AVAILABLE TO THE PUBLIC  UNDER  SECTION  TWENTY-
EIGHT  HUNDRED FIVE-T OF THIS CHAPTER.  INFORMATION UNDER THIS PARAGRAPH
SHALL BE DISPLAYED IN A FORM APPROVED BY THE DEPARTMENT AND BE POSTED IN
A MANNER WHICH IS VISIBLE AND ACCESSIBLE TO  RESIDENTS,  THEIR  FAMILIES
AND THE STAFF, AS REQUIRED BY THE COMMISSIONER.
  (B)  A  RESIDENTIAL  HEALTH CARE FACILITY SHALL POST A SUMMARY OF THIS
SECTION, PROVIDED BY  THE  DEPARTMENT,  IN  PROXIMITY  TO  EACH  POSTING
REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVISION.
  § 7. If any provision of this act, or any application of any provision
of  this  act,  is held to be invalid, or ruled by any federal agency to
violate or be inconsistent with any  applicable  federal  law  or  regu-
lation, that shall not affect the validity or effectiveness of any other
provision  of  this act, or of any other application of any provision of
this act.
  § 8. This act shall take effect on the one hundred eightieth day after
it shall have become a law, provided that any rules and regulations, and
any other actions necessary to implement the provisions of this  act  on
its  effective  date  are  authorized and directed to be completed on or
before such date.