Report Title:

Nurses; Safe Nurse Staffing

Description:

Provides for patient protection by requiring safe nurse staffing.

HOUSE OF REPRESENTATIVES

H.B. NO.

2121

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

RELATING TO SAFE NURSE STAFFING.

 

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

SECTION 1. The legislature finds as follows:

(1) There are hospitals and other health care facilities throughout the State that have inadequate staffing of registered nurses to protect the well being and health of the patients;

(2) Studies show that the health of patients is directly proportionate to the number of registered nurses working in the health care facility;

(3) There is a worldwide shortage of registered nurses. Hawaii already suffers from a nursing shortage, and that shortage is expected to become critical in the next ten years;

(4) The effect of that shortage is revealed in unsafe staffing levels in health care facilities;

(5) Patient’s health and safety are adversely affected by these unsafe staffing levels, creating a public health crisis;

(6) Nurses are being required to perform professional services under conditions that do not support quality health care or a healthful work environment for registered nurses and licensed practical nurses; and

(7) As the entity responsible for the inspection and licensing of health care facilities, and as a payor for inpatient and outpatient hospital services for individuals entitled to benefits under the medicaid program, the State has a compelling interest in promoting the health and safety of patients, by requiring a health care facility participating in the program to establish safe staffing levels for registered nurses.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part   . Nurse staffing

§321-A Definitions. As used in this part, the following terms shall mean as follows:

"Department" means the department of health.

"Director" means the director of health.

"Nurse" means an individual who has been granted a license to practice as a registered nurse or licensed practical nurse under chapter 457.

"Participating hospital or other health care facility" includes health care facilities and health care services as defined in section 323D-2.

"Person" means one or more individuals, associations, corporations, or labor unions.

"Shift" means a scheduled set of hours or duty period to be worked at a participating facility or hospital.

"Unit" means an organizational department or separate geographic area of a hospital or other health care facility providing health care services for a cost.

§321-B Participating hospitals or health care facilities; staffing system; generally. (a) Each participating hospital or health care facility shall adopt and implement a staffing system that ensures a number of registered nurses on each shift and in each unit of the health care facility to ensure appropriate staffing levels for patient care.

(b) Additionally, each participating hospital or other health care facility shall:

(1) Post daily for each shift, in a clearly visible place, a document that specifies in a uniform manner the current number of licensed and unlicensed nursing staff directly responsible for patient care in each unit of the facility, identifying specifically the number of registered nurses; and

(2) Upon request, make available to the public both the nursing staff information and a detailed written description of the staffing system established by the facility.

§321-C Staffing system requirements; limitations. (a) Staffing systems shall:

(1) Be based upon input from the direct care-giving registered nurse staff or their exclusive representatives, as well as the chief nurse executive;

(2) Be based upon the number of patients and the level and variability of intensity of care to be provided, with appropriate consideration given to admissions, discharges, and transfers during each shift;

(3) Account for contextual issues affecting staffing and the delivery of care, including architecture and geography of the environment and available technology;

(4) Reflect the level of preparation and experience of those providing care;

(5) Account for staffing level effectiveness or deficiencies in related health care classifications, including but not limited to certified nurse assistants, licensed vocational nurses, licensed psychiatric technicians, nursing assistants, aides, hemo technicians, and orderlies;

(6) Reflect staffing levels recommended by specialty nursing organizations;

(7) Establish upwardly adjustable registered nurse-to-patient ratios based upon registered nurses’ assessment of patient acuity and existing conditions;

(8) Provide that a registered nurse shall not be assigned to work in a particular unit without first having established the ability to provide professional care in that unit; and

(9) Be based on methods that ensure validity and reliability.

(b) A staffing system may not:

(1) Set registered nurse levels below those required by federal or state law; or

(2) Utilize any minimum registered nurse-to-patient ratio.

§321-D Enforcement; remedies. (a) The director shall adopt rules under chapter 91 to enforce this part, including procedures for receiving and investigating complaints. These procedures shall ensure that any person may file a complaint that a participating health care facility has violated this part.

(b) If the director determines that a participating health care facility has violated this part, the director:

(1) Shall require the facility to establish a corrective plan to prevent the recurrence of the violation; and

(2) May impose civil fines of not more than $10,000 for each violation; provided that the director may impose civil fines of not more than $20,000 for each violation indicative of a pattern or practice of disregard of the law.

(c) The director shall publish on the web site of the department the names of all participating facilities that have been fined by the director for a violation of this part."

SECTION 3. Section 321-11, Hawaii Revised Statutes, is amended to read as follows:

"§321-11 Subjects of health rules, generally. The department pursuant to chapter 91 may adopt rules that it deems necessary for the public health and safety respecting:

(1) Nuisances, foul or noxious odors, gases, vapors, waters in which mosquitoes breed or may breed, sources of filth, and causes of sickness or disease, within the respective districts of the State, and on board any vessel;

(2) Adulteration and misbranding of food or drugs;

(3) Location, air space, ventilation, sanitation, drainage, sewage disposal, and other health conditions of buildings, courts, construction projects, excavations, pools, watercourses, areas, and alleys;

(4) Privy vaults and cesspools;

(5) Fish and fishing;

(6) Interments and dead bodies;

(7) Disinterments of dead human bodies, including the exposing, disturbing, or removing of these bodies from their place of burial, or the opening, removing, or disturbing after due interment of any receptacle, coffin, or container holding human remains or a dead human body or a part thereof and the issuance and terms of permits for the [aforesaid] disinterments of dead human bodies;

(8) Cemeteries and burying grounds;

(9) Laundries, and the laundering, sanitation, and sterilization of articles including linen and uniforms used by or in the following businesses and professions: barber shops, manicure shops, beauty parlors, electrology shops, restaurants, soda fountains, hotels, rooming and boarding houses, bakeries, butcher shops, public bathhouses, midwives, [masseurs,] massage therapists, and others in similar calling, public or private hospitals, and canneries and bottling works where foods or beverages are canned or bottled for public consumption or sale; provided that nothing in this chapter shall be construed as authorizing the prohibiting of laundering, sanitation, and sterilization by those conducting any of these businesses or professions where the laundering or sterilization is done in an efficient and sanitary manner;

(10) Hospitals, freestanding surgical outpatient facilities, skilled nursing facilities, intermediate care facilities, adult residential care homes, adult foster homes, assisted living facilities, special treatment facilities and programs, home health agencies, hospices, and freestanding birthing facilities, provided that rules for participating hospitals and other health care facilities that provide both inpatient and outpatient services provide for safe nurse staffing levels pursuant to part     , adult day health centers, independent group residences, and therapeutic living programs, but excluding youth shelter facilities unless clinical treatment of mental, emotional, or physical disease or handicap is a part of the routine program or constitutes the main purpose of the facility, as defined in section 346-16 under "child care institution". For the purpose of this paragraph, "adult foster home" has the same meaning as provided in section 321-11.2;

(11) Hotels, rooming houses, lodging houses, apartment houses, tenements, and residences for persons with developmental disabilities including, but not limited to, those built under federal funding;

(12) Laboratories;

(13) Any place or building where noisome or noxious trades or manufacturers are carried on, or intended to be carried on;

(14) Milk;

(15) Poisons and hazardous substances, the latter term including but not limited to any substance or mixture of substances which:

(A) Is corrosive;

(B) Is an irritant;

(C) Is a strong sensitizer;

(D) Is inflammable; or

(E) Generates pressure through decomposition, heat, or other means,

if the substance or mixture of substances may cause substantial personal injury or substantial illness during or as a proximate result of any customary or reasonably foreseeable handling or use, including reasonably foreseeable ingestion by children;

(16) Pig and duck ranches;

(17) Places of business, industry, employment, and commerce, and the processes, materials, tools, machinery, and methods of work done therein; and places of public gathering, recreation, or entertainment;

(18) Any restaurant, theater, market, stand, shop, store, factory, building, wagon, vehicle, or place where any food, drug, or cosmetic is manufactured, compounded, processed, extracted, prepared, stored, distributed, sold, offered for sale, or offered for human consumption or use;

(19) Foods, drugs, and cosmetics, and the manufacture, compounding, processing, extracting, preparing, storing, selling, and offering for sale, consumption, or use of any food, drug, or cosmetic;

(20) Devices as defined in section 328-1;

(21) Sources of ionizing radiation;

(22) Medical examination, vaccination, revaccination, and immunization of school children. No child shall be subjected to medical examination, vaccination, revaccination, or immunization, whose parent or guardian objects in writing thereto on grounds that the requirements are not in accordance with the religious tenets of an established church of which the parent or guardian is a member or adherent, but no objection shall be recognized when, in the opinion of the department, there is danger of an epidemic from any communicable disease;

(23) Disinsectization of aircraft entering or within the State as may be necessary to prevent the introduction, transmission, or spread of disease or the introduction or spread of any insect or other vector of significance to health;

(24) Fumigation, including the process by which substances emit or liberate gases, fumes, or vapors which may be used for the destruction or control of insects, vermin, rodents, or other pests, which, in the opinion of the department, may be lethal, poisonous, noxious, or dangerous to human life;

(25) Ambulances and ambulance equipment;

(26) Development, review, approval, or disapproval of management plans submitted pursuant to the Asbestos Hazard Emergency Response Act of 1986, Public Law 99-519; and

(27) Development, review, approval, or disapproval of an accreditation program for specially trained persons pursuant to the Residential Lead-Based Paint Hazard Reduction Act of 1992, Public Law 102-550.

The department may require any certificates, permits, or licenses that it may deem necessary to adequately regulate the conditions or businesses referred to in this section."

SECTION 4. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect on January 1, 2005.

INTRODUCED BY:

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