S T A T E O F N E W Y O R K
________________________________________________________________________
7425
I N S E N A T E
January 17, 2018
___________
Introduced by Sen. FUNKE -- read twice and ordered printed, and when
printed to be committed to the Committee on Health
AN ACT to amend the public health law, in relation to implementing a
"safe staffing for quality care demonstration program"; and providing
for the repeal of such provisions upon expiration thereof
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The public health law is amended by adding six new
sections 2827, 2828, 2829, 2830, 2831 and 2832 to read as follows:
§ 2827. THE DEPARTMENT SHALL FACILITATE A SAFE STAFFING DEMONSTRATION
PROGRAM IN ACCORDANCE WITH SECTION TWENTY-EIGHT HUNDRED THIRTY OF THIS
ARTICLE. SUCH PROGRAM SHALL CONSIST OF A MAXIMUM OF THREE ACUTE CARE
FACILITIES LOCATED IN THREE DIFFERENT EMPIRE STATE DEVELOPMENT ZONES AS
ESTABLISHED IN ARTICLE EIGHTEEN-B OF THE ECONOMIC DEVELOPMENT LAW. TWO
OF THE ZONES SHALL BE LOCATED IN UPSTATE AND ONE IN DOWNSTATE. THE
DEPARTMENT SHALL DEVELOP CRITERIA AND AN APPLICATION PROCESS FOR PARTIC-
IPATION IN THE DEMONSTRATION PROGRAM. PARTICIPATION IN THE PROGRAM BY
FACILITIES SHALL BE VOLUNTARY. ANY COSTS INCURRED BY SELECTED APPLICANTS
SHALL BE REIMBURSED BY THE STATE.
§ 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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13960-01-7
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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
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-NINE, TWENTY-EIGHT
HUNDRED THIRTY, TWENTY-EIGHT HUNDRED THIRTY-ONE AND TWENTY-EIGHT HUNDRED
THIRTY-TWO 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. 1. THE COMMIS-
SIONER SHALL APPOINT AN ACUTE CARE FACILITY COUNCIL CONSISTING OF THIR-
TEEN MEMBERS. NO LESS THAN SEVEN MEMBERS SHALL BE REGISTERED PROFES-
SIONAL 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
ADMINISTRATOR. NO LESS THAN TWO MEMBERS OF THE ACUTE CARE FACILITY COUN-
CIL SHALL BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE
BARGAINING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT
LEAST TWO REPRESENTATIVES OF ACUTE CARE FACILITIES, ONE REPRESENTATIVE
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OF A NURSING PROFESSIONAL ASSOCIATION, AND ONE REPRESENTATIVE OF A
RECOGNIZED OR CERTIFIED BARGAINING AGENT OF NURSES.
2. THE ACUTE CARE FACILITY COUNCIL SHALL ADVISE THE COMMISSIONER IN
THE DEVELOPMENT OF REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING
REQUIREMENTS AND NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS THAT
ARE NOT OTHERWISE SPECIFIED IN THIS ARTICLE; THE EFFICACY OF ACUITY
SYSTEMS SUBMITTED FOR APPROVAL BY THE COMMISSIONER; THE DEVELOPMENT OF
AN ASSESSMENT TOOL USED TO EVALUATE THE EFFICACY OF ACUITY SYSTEMS; AND
REVIEW AND MAKE RECOMMENDATIONS ON APPROVAL OF STAFFING PLANS TO BE USED
BY FACILITIES SELECTED FOR PARTICIPATION IN THE DEMONSTRATION PROGRAM.
§ 2830. STAFFING REQUIREMENTS; DEMONSTRATION PROGRAM. 1. STAFFING
REQUIREMENTS. EACH PARTICIPATING ACUTE CARE FACILITY SHALL ENSURE THAT
IT IS STAFFED IN A MANNER THAT PROVIDES SUFFICIENT, APPROPRIATELY QUALI-
FIED DIRECT-CARE NURSES IN EACH DEPARTMENT 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 SUBDIVI-
SIONS TWO AND THREE OF THIS SECTION.
2. STAFFING PLAN. EACH PARTICIPATING ACUTE CARE FACILITY SHALL SUBMIT
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:
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(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;
(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 GUIDELINES 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
EACH PARTICIPATING 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 DETERMINING NURSING CARE REQUIREMENTS, INCLUDING THE SEVERITY OF THE
ILLNESS, THE NEED FOR SPECIALIZED EQUIPMENT AND TECHNOLOGY, THE COMPLEX-
ITY OF CLINICAL JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND EVALUATE THE
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PATIENT CARE PLAN AND THE ABILITY FOR SELF-CARE, AND THE LICENSURE OF
THE PERSONNEL REQUIRED FOR CARE.
7. 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
PARTICIPATING 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, HOWEV-
ER, 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. PARTICIPATING 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
COMPETENCY 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 REGULAR-
LY OCCURRING WITHIN THE FACILITY.
3. EACH PARTICIPATING 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 PARTICIPATING ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATIS-
TICS, BY NURSING DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY,
INFECTION, ACCIDENT, INJURY AND MEDICAL ERRORS.
§ 2832. WORK ASSIGNMENT POLICY. 1. GENERAL. EACH PARTICIPATING 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:
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(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.
§ 2. The department of health shall publish a report containing the
data for each year of the program and for each participating facility.
Such report shall include, but not be limited to:
1. the impact that the new staffing levels had on payroll;
2. overall cost for each facility to implement the new staffing stand-
ards;
3. the number of patients who re-enter care in this facility, exclud-
ing routine follow-up care, after having been treated there at least
once during the program time frame; and
4. (i) any reduction or increase in sick days used by nurses in these
participating facilities, (ii) any reduction or increase in workers'
compensation claims filed by nurses, and (iii) any reduction or increase
in overtime used by nurses.
§ 3. 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; and provided, further that this act shall expire and
be deemed repealed three years after such effective date.
