Report Title:
Hospitals; Staffing
Description:
Requires health care facilities to ensure patient protection by providing safe nurse staffing.
THE SENATE |
S.B. NO. |
2351 |
TWENTY-SECOND LEGISLATURE, 2004 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO HOSPITAL CARE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that the State has a substantial interest in ensuring that delivery of health care services to patients in health care facilities located within this State is sufficient and safe and that health care facilities retain adequate nursing staff so as to promote optimal health care outcomes.
The legislature further finds that there is a nationwide shortage of registered nurses and Hawaii is not immune to that shortage. According to the American Hospital Association, the shortage of full-time registered nurses nationwide has been estimated at one hundred twenty-six thousand, or thirteen per cent of the nation's work force. That number is expected to rise to thirty per cent, or eight hundred eight thousand, by 2020. While the severity of the shortage varies from state to state, Hawaii, in 2001, had a shortage of four hundred nurses.
Health care facilities in Hawaii that have inadequate staffing of registered nurses are ill-equipped to protect the well being and health of their patients, and also lends themselves to dangerous medical errors and patient infections. Studies show that the health of a patient is directly correlated with the number of registered nurses working in a health care facility. Too low a number, and patients' health and safety are compromised, creating a public health crisis.
The legislature further finds that to alleviate the consequences of nurse shortage, some hospitals require nurses to work substantial overtime hours, and nurses working twelve-hour shifts work the most additional overtime hours per week. Mandatory overtime and lengthy work hours for direct-care nurses constitute a threat to the health and safety of patients, adversely impact the general well-being of nurses, and result in greater turnover, which increases long-term shortages of nursing personnel.
The purpose of this Act is to ensure patient protection by requiring health facilities to safely staff registered nurses.
SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:
"Chapter
SAFE STAFFING FOR HOSPITAL CARE
§ -1 Definitions. As used in this chapter, unless the context otherwise requires:
"Director" means the director of health.
"Shift" means a scheduled set of hours or duty period to be worked at a health care facility.
"Unit" means an organizational department or separate geographic area of a health care facility providing healthcare services for a cost.
§ -2 Minimum staffing ratios, establishment. (a) Each health care facility, as defined in section 323D-2, shall ensure that it is staffed in a manner that provides sufficient and appropriately qualified nursing staff, as defined under chapter 457, by adopting and implementing a staffing system.
(b) A staffing system adopted and implemented by a health care facility 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 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 such unit; and
(9) Be based on methods that assure validity and reliability.
(c) A staffing system as described in subsection (a) shall not:
(1) Set registered nurse levels below those required by any federal or state law or regulation; or
(2) Utilize any minimum registered nurse-to-patient ratio.
(d) Each health care facility shall:
(1) Conspicuously post daily for each shift a document that specified in a uniform manner the current number of licensed and unlicensed nursing staff directly responsible for patient care in each unit of the health care facility, identifying specifically the number of registered nurses;
(2) Make available to the public upon request:
(A) Nursing staff information; and
(B) A detailed written description of the staffing system established by the facility.
§ -3 Enforcement and penalties. (a) The director shall enforce the requirements and prohibitions of this section in accordance with the succeeding provisions of this section.
(b) The director shall establish procedures under which:
(1) Any person may file a complaint that a participating health care facility has violated a requirement or a prohibition of this section; and
(2) Complaints are investigated by the director.
(c) If the director determines that a health care facility has violated a requirement of this section, the director:
(1) Shall require the facility to establish a corrective action plan to prevent the recurrence of such violation;
(2) May impose civil penalties under this paragraph, notwithstanding any other penalties prescribed by law, of not more than $10,000 for each knowing violation of a requirement of this chapter; provided that the director shall impose a civil penalty of more than $10,000 for each such violation in the case of a health care facility that the director determines has a pattern or practice of such violations; and
(3) The director shall publish on the department's internet site the names of facilities on which civil money penalties have been imposed, the violation for which the penalty was imposed, and additional information determined appropriate by the director.
§ -4 Rules. The director may adopt rules pursuant to chapter 91 as may be necessary to implement this chapter."
SECTION 3. This Act shall take effect upon its approval.
INTRODUCED BY: |
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