Senate File 2296 - Introduced SENATE FILE BY BOLKCOM Passed Senate, Date Passed House, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act relating to nurse staffing levels in hospitals and 2 providing a penalty. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 6049XS 82 5 jr/nh/8 PAG LIN 1 1 Section 1. NEW SECTION. 135B.35 TITLE. 1 2 This division may be cited as the "Hospital Staffing Plans 1 3 Act". 1 4 Sec. 2. NEW SECTION. 135B.36 DEFINITIONS. 1 5 As used in this division: 1 6 1. "Department" means the department of public health. 1 7 2. "Director" means the director of the department of 1 8 public health. 1 9 3. "Intensity" means the level of patient needs as 1 10 determined by a registered nurse providing direct patient 1 11 care, taking into account at least all of the following 1 12 factors: 1 13 a. The severity and urgency of the patient's admitting 1 14 condition. 1 15 b. Scheduled procedures. 1 16 c. The patient's ability to meet health care requisites. 1 17 d. The patient's availability of social supports. 1 18 e. The age and functional ability of the patient. 1 19 f. Communication skills of the patient. 1 20 g. Other needs identified by the patient and the 1 21 registered nurse. 1 22 4. "Patient care unit" means any unit of a hospital that 1 23 provides patient care. 1 24 5. "Skill mix" means the number of registered nurses, 1 25 licensed practical nurses, and other personnel providing 1 26 direct patient care. 1 27 6. "State board" means the state board of health. 1 28 Sec. 3. NEW SECTION. 135B.37 STAFFING COMMITTEE. 1 29 Each hospital shall appoint a staffing committee to assist 1 30 in the development and implementation of a staffing plan for 1 31 the hospital. At least one=half of the members of the 1 32 staffing committee shall be registered nurses currently 1 33 providing direct patient care in the hospital. If the 1 34 registered nurses employed by the hospital have elected a 1 35 collective bargaining representative, the registered nurse 2 1 representatives on the staffing committee shall be selected by 2 2 the collective bargaining representative. Participation in 2 3 the staffing committee shall be considered part of the 2 4 employee's regularly scheduled work hours. 2 5 Sec. 4. NEW SECTION. 135B.38 STAFFING PLAN FOR NURSING 2 6 SERVICES. 2 7 1. By July 1, 2009, each hospital shall develop and 2 8 implement a staffing plan for nursing services. The hospital 2 9 shall collaborate with its staffing committee in the 2 10 development and implementation of the staffing plan. The 2 11 hospital shall file the staffing plan with the department, 2 12 post the staffing plan for each patient care unit in the 2 13 appropriate patient care unit in the hospital, and provide a 2 14 copy of the applicable staffing plan to a current or 2 15 prospective patient of a patient care unit upon request. The 2 16 hospital, in collaboration with its staffing committee, shall 2 17 review and update its staffing plan annually and file any 2 18 updated staffing plan with the department. The department 2 19 shall include each hospital's current staffing plan on the 2 20 hospital report card developed and made available pursuant to 2 21 section 135B.45. 2 22 2. A hospital staffing plan shall do all of the following: 2 23 a. Set the minimum skill mix required in each patient care 2 24 unit in the hospital based on the following criteria: 2 25 (1) Patient census information, including patient 2 26 discharges, admissions, and transfers. 2 27 (2) Level of intensity of all patients and the nature of 2 28 the care to be delivered on each shift. 2 29 (3) The skill level, experience, and specialty 2 30 certification or training of those persons providing care in 2 31 the unit. 2 32 (4) The need for specialized or intensive equipment. 2 33 b. Include appropriate limits on the use of agency and 2 34 traveling nurses. 2 35 c. Be consistent with the scopes of practice of registered 3 1 nurses and licensed practical nurses and the authorized duties 3 2 of other personnel providing direct patient care. 3 3 d. Include adequate administrative staff in each patient 3 4 care unit to ensure that nurses providing direct patient care 3 5 are not hindered in the delivery of that care. 3 6 e. Include a process for an annual internal review by the 3 7 staffing committee that ensures compliance with the staffing 3 8 plan, provides for review of incidents and staff concerns, and 3 9 tracks staffing patterns and the number of patients and their 3 10 acuity. 3 11 f. Comply with and not diminish existing standards in any 3 12 applicable collective bargaining agreement. 3 13 Sec. 5. NEW SECTION. 135B.39 HOSPITAL STAFFING. 3 14 1. A hospital shall staff each patient care unit in 3 15 accordance with its staffing plan. The hospital may deviate 3 16 from a staffing plan in cases of emergency, as determined by 3 17 the hospital. The hospital shall make a record of any 3 18 deviation from a staffing plan and report the deviation to the 3 19 department in a manner determined by the department by rule. 3 20 2. A hospital shall maintain and post a list of qualified, 3 21 on=call nursing staff and nursing services that may be called 3 22 to provide replacement staff in the event of sickness, 3 23 vacations, vacancies, and other absences of nursing staff. 3 24 The list shall provide a sufficient number of replacement 3 25 staff for the hospital on a regular basis. 3 26 Sec. 6. NEW SECTION. 135B.40 RECORDKEEPING AND 3 27 REPORTING. 3 28 1. A hospital shall maintain accurate daily records 3 29 containing all of the following: 3 30 a. The number of patients present in each patient care 3 31 unit at the end of each standard shift within the hospital. 3 32 b. The number of admissions, discharges, transfers, and 3 33 observation patients in each patient care unit during each 3 34 shift. 3 35 c. The skill mix in each patient care unit during each 4 1 shift. 4 2 2. The daily records shall be retained for at least seven 4 3 years and shall be made available upon request to the 4 4 department and the staffing committee. 4 5 3. At least twice a year, a hospital shall collect and 4 6 submit to the department the following nurse staffing 4 7 information: 4 8 a. The mix of registered nurses, licensed practical 4 9 nurses, and other personnel caring for patients as a 4 10 percentage of the total of all nursing care hours in each 4 11 patient care unit. 4 12 b. The total nursing care hours provided per patient day 4 13 in each patient care unit. 4 14 c. The average number of pressure ulcers per patient. 4 15 d. The average number of patient falls per one thousand 4 16 patient days. 4 17 Sec. 7. NEW SECTION. 135B.41 RETALIATION PROHIBITED. 4 18 A hospital shall not retaliate against or intimidate an 4 19 employee for performing any duties or responsibilities in 4 20 connection with participation on the staffing committee. A 4 21 hospital shall not retaliate against or intimidate an employee 4 22 who notifies the staffing committee, the hospital's 4 23 administration, or the department that a staffing schedule for 4 24 a patient care unit fails to comply with the posted staffing 4 25 plan or that the hospital has failed to develop or implement a 4 26 staffing plan as required by this division. 4 27 Sec. 8. NEW SECTION. 135B.42 PENALTIES. 4 28 1. The department shall investigate complaints of 4 29 violations of this division and may impose civil penalties, 4 30 not to exceed five thousand dollars per day per violation, or 4 31 suspend or revoke a hospital's license for a violation of this 4 32 division. Each violation of a staffing plan shall be 4 33 considered a separate violation. 4 34 2. The department shall maintain, and make available to 4 35 the public, records of any civil penalties, administrative 5 1 actions, or license suspensions or revocations imposed on 5 2 hospitals for a violation of this section. 5 3 Sec. 9. NEW SECTION. 135B.43 REPORT TO THE GENERAL 5 4 ASSEMBLY. 5 5 The department shall submit an annual report to the general 5 6 assembly regarding hospital staffing plans, including 5 7 information pertaining to hospital compliance with the 5 8 requirements of this division. The department shall make the 5 9 report available to the public. 5 10 Sec. 10. NEW SECTION. 135B.44 RULES. 5 11 The state board shall adopt rules as necessary to implement 5 12 this division. 5 13 Sec. 11. NEW SECTION. 135B.45 HOSPITAL REPORT CARD == 5 14 STAFFING PLANS. 5 15 1. The director shall establish an Iowa hospital report 5 16 card consisting of the data assembled pursuant to this 5 17 division, including the hospital staffing plans required by 5 18 section 135B.38, and the nurse staffing information required 5 19 by section 135B.40. At a minimum, the data, hospital staffing 5 20 plans, and nurse staffing information shall be made available 5 21 on an internet web site in a manner that allows consumers to 5 22 conduct an interactive search that allows them to view and 5 23 compare the information for specific hospitals. The web site 5 24 shall include such additional information as is determined 5 25 necessary to ensure that the web site enhances informed 5 26 decision making among consumers and health care purchasers, 5 27 which shall include, at a minimum, appropriate guidance on how 5 28 to use the data, hospital staffing plans, and nurse staffing 5 29 information and an explanation of why the data, hospital 5 30 staffing plans, or nurse staffing information may vary from 5 31 hospital to hospital. All information specified in this 5 32 subsection shall be released on or before July 1, 2010, and 5 33 shall be updated on a regular basis. 5 34 2. Prior to the completion of the Iowa hospital report 5 35 card, the director shall ensure that every hospital is allowed 6 1 thirty days within which to examine the data, hospital 6 2 staffing plans, and nurse staffing information and submit 6 3 comments for consideration and inclusion in the final Iowa 6 4 hospital report card. 6 5 EXPLANATION 6 6 This bill requires, by July 1, 2009, hospitals to develop 6 7 staffing plans that establish the minimum number of registered 6 8 nurses, licensed practical nurses, and other personnel 6 9 providing direct patient care required in each patient care 6 10 unit in the hospitals. Each hospital must appoint a staffing 6 11 committee to assist in the development and implementation of a 6 12 staffing plan. At least one=half of the members of the 6 13 committee must be registered nurses currently providing direct 6 14 patient care in the hospital. 6 15 Plans must be filed with the department of public health 6 16 and be made available to patients upon request. The bill 6 17 requires hospitals to staff each patient care unit as provided 6 18 in the staffing plan. However, the bill does allow a 6 19 modification to the staffing plan for a particular patient 6 20 care unit in an emergency. Hospitals must maintain accurate 6 21 daily records and submit nurse staffing information to the 6 22 department at least semiannually. 6 23 The bill prohibits a hospital from retaliating against an 6 24 employee for participating on the staffing committee or 6 25 notifying the staffing committee, the hospital's 6 26 administration, or the department of a deviation from a 6 27 staffing plan or failure to develop or implement a staffing 6 28 plan. 6 29 The bill requires the department to investigate complaints 6 30 of violations. The department may impose civil penalties up 6 31 to five thousand dollars per day per violation, or suspend or 6 32 revoke a hospital's license for violation of these 6 33 requirements. Each violation of a staffing plan shall be 6 34 considered a separate violation. 6 35 The bill directs the director of public health to establish 7 1 a hospital report card. The report card consists of the data 7 2 collected pursuant to these provisions, including the hospital 7 3 staffing plans, and the nurse staffing information. This 7 4 information is to be available on an internet web site. The 7 5 web site must include additional information as necessary to 7 6 ensure that the web site enhances informed decision making 7 7 among consumers and health care purchasers. The information 7 8 shall be released on or before July 1, 2010, and shall be 7 9 updated regularly. 7 10 The bill requires the department to submit an annual report 7 11 to the general assembly regarding hospital compliance with 7 12 these requirements. 7 13 LSB 6049XS 82 7 14 jr/nh/8