Minnesota Legislature
HF 1654
as introduced - 89th Legislature (2015 - 2016) Posted on 04/26/2016 12:40pm
Bill Text Versions
| Engrossments | ||
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| Introduction | Posted on 03/09/2015 |
Current Version - as introduced
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A bill for an act
relating to health; requiring hospitals to provide staffing at levels consistent with
nationally accepted standards; requiring reporting of staffing levels; imposing
civil penalties; amending Minnesota Statutes 2014, sections 144.7055; 144.7065,
by adding subdivisions; 148.264, subdivision 1; proposing coding for new law in
Minnesota Statutes, chapter 144.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
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[144.591] SAFE PATIENT STANDARD ACT.
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new text begin Subdivision 1. new text end
new text begin Title. new text end
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This section may be cited as the "Safe Patient Standard Act."
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new text begin Subd. 2. new text end
new text begin Definitions. new text end
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(a) For purposes of this section, the following terms have
the meanings given.
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(b) "Assignment" means the provision of care to a patient for whom a direct-care
registered nurse has responsibility within the nurse's scope of practice.
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(c) "Commissioner" means the commissioner of health.
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(d) "Direct-care registered nurse" means a registered nurse, as defined in section
148.171, who is nonsupervisory and nonmanagerial and is directly providing nursing care
to patients more than 60 percent of the time.
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(e) "Nursing intensity" means a patient-specific, not diagnosis-specific, measurement
of nursing care resources expended during a patient's hospitalization. A measurement of
nursing intensity includes the complexity of care required for a patient and the knowledge
and skill needed by a nurse for surveillance of patients in order to make continuous,
appropriate clinical decisions in the care of patients.
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(f) "Patient acuity" means the measure of a patient's severity of illness or medical
condition including, but not limited to, the stability of physiological and psychological
parameters and the dependency needs of the patient and the patient's family. Higher
patient acuity requires more intensive nursing time and advanced nursing skills for
continuous surveillance.
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(g) "Skill mix" means the composition of nursing staff by licensure and education
including, but not limited to, registered nurses, licensed practical nurses, and unlicensed
personnel.
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(h) "Surveillance" means the continuous process of observing patients for early
detection and intervention in an effort to prevent negative patient outcomes.
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(i) "Unit" means an area or location of a hospital where patients receive care based
on similar patient acuity and nursing intensity.
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new text begin Subd. 3. new text end
new text begin Staffing. new text end
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(a) As a condition of licensure, hospitals must, at all times,
provide enough qualified registered nursing personnel on duty to provide the standard of
care that is necessary for the well-being of the patients, consistent with nationally accepted
evidence-based standards established by professional nursing specialty organizations and
the commissioner.
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(b) The commissioner shall create a working group by September 1, 2015, to review
evidence-based research established by professional nursing specialty organizations,
including, but not limited to:
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(1) Association of Women's Health, Obstetric and Neonatal Nurses;
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(2) Association of Operating Room Nurses;
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(3) Emergency Nurses Association; and
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(4) American Association of Critical Care Nurses.
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(c) The commissioner shall consider the suggestions of the working group and
other evidence-based research and, by March 1, 2016, develop a minimum standard of
qualified registered nursing personnel required to be on duty to provide the standard
of care that is necessary for the well-being of patients. This standard must not allow a
hospital to average the number of patients and the total number of direct-care registered
nurses assigned to patients in a unit during any one shift or over any period of time for
purposes of meeting the requirements under this section.
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(d) The working group must be staffed by the commissioner or the commissioner's
designee and must include 12 members as appointed by the governor, at least seven
of whom shall be chosen from the affiliated membership of the Minnesota Nurses
Association. The 12 members must specifically include the following:
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(1) one member who represents the Minnesota Hospital Association;
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(2) one member who represents the Minnesota Nurses Association;
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(3) two members of the public;
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(4) two members who are direct-care registered nurses and represent greater
Minnesota;
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(5) two members who are direct-care registered nurses and represent the
metropolitan area;
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(6) two members who are direct-care registered nurses and represent hospitals
licensed for 25 beds or less; and
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(7) two members who are direct-care registered nurses and represent hospitals
licensed for more than 25 beds.
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(e) Costs incurred for staffing and managing this working group shall be paid for
with hospital licensing fees and the working group shall dissolve upon the commissioner
establishing the minimum standard of care under paragraph (c) or by September 1, 2017,
whichever is sooner.
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new text begin Subd. 4. new text end
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Assignment adjustments and adding additional registered nurses.
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(a) Hospitals must assign nursing personnel to each patient care unit consistent with
provisions developed by the commissioner under subdivision 3. A direct-care nurse shall
evaluate the following factors to assess and determine adequacy of staffing levels to
meet patient care needs:
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(1) composition of skills and roles available;
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(2) patient acuity;
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(3) experience level of registered nurse staff;
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(4) unit activity level, such as admissions, discharges, and transfers;
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(5) variable staffing grids; and
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(6) availability of a registered nurse to accept an assignment.
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(b) If any direct-care registered nurse determines that staffing levels are inadequate
and notifies a manager or administrative supervisor, the manager or administrative
supervisor shall consider the following:
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(1) current patient care assignments for potential redistribution;
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(2) the ability to facilitate discharges, transfers, and admissions;
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(3) the availability of additional staffing resources; and
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(4) the hospitalwide census and staffing.
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(c) If the staffing inadequacies cannot be resolved and resources cannot be
reallocated by the manager or administrative supervisor after consideration of the factors
in paragraph (b), the hospital shall call in extra staff to ensure adequate staffing to meet
safe patient standards as established in subdivision 3.
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(d) Hospitals must not use mandatory overtime as a means to meet staffing
standards. Until extra staff arrive and begin to receive patient assignments, the hospital
must suspend nonemergency admissions and elective surgeries that routinely lead to
in-patient hospitalization.
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new text begin Subd. 5. new text end
new text begin Safe Patient Assignment Committee. new text end
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(a) By October 1, 2015, every
hospital licensed in the state must establish a Safe Patient Assignment Committee either
by creating a new committee or assigning the functions of a staffing for patient safety
committee to an existing committee.
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(b) Membership of the committee must include, but is not limited to, the following
members:
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(1) at least 60 percent of the membership must be nonsupervisory and nonmanagerial
registered nurses who provide direct patient care, as defined in subdivision 2, paragraph
(d); and
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(2) members appointed by a collective bargaining unit to proportionately represent
its nurses.
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Hospitals must compensate registered nurses who are employed by the hospital and serve
on the Safe Patient Assignment Committee for time spent on committee business.
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(c) Safe Patient Assignment Committees shall:
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(1) complete a staffing for patient safety assessment by March 31, 2016, and
annually thereafter that identifies the following:
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(i) problems of insufficient staffing including, but not limited to, inappropriate
number of registered nurses scheduled in a unit, inappropriately experienced registered
nurses scheduled for a particular unit, inability for nurse supervisors to adjust for increased
acuity or activity in a unit, and chronically unfilled positions within the hospital;
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(ii) units that pose the highest risk to patient safety due to inadequate staffing; and
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(iii) solutions for problems identified under items (i) and (ii);
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(2) implement and evaluate staffing standards provided in subdivision 3;
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(3) convert standards described in subdivision 3 into registered nurse hours of care
per patient;
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(4) recommend a mechanism for tracking and analyzing staffing trends within the
hospital;
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(5) develop a procedure for making shift-to-shift adjustments in staffing levels
consistent with subdivision 4 when such adjustments are required by patient acuity and
nursing intensity; and
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(6) identify any incidents when the hospital has failed to meet the standards provided
in subdivision 3 and recommend a remedy.
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new text begin Subd. 6. new text end
new text begin Retaliation. new text end
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A direct-care registered nurse may not be retaliated against or
be disciplined by the hospital, either formally or informally, for:
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(1) refusing to accept an assignment if, in good faith and in the nurse's professional
judgment, the nurse determined that the assignment is unsafe for patients due to patient
acuity and nursing intensity; or
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(2) reporting a concern regarding safe staffing levels.
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new text begin Subd. 7. new text end
new text begin Enforcement. new text end
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(a) The commissioner shall impose a civil penalty of not
less than $25,000 for each hospital failing to comply with the provisions of this section,
including failure to staff patient care units to required levels.
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(b) The commissioner must publicly report, at a minimum, on its Web site all
incidents of noncompliance with any provision within this section on a quarterly basis,
starting September 1, 2015.
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Sec. 2.
Minnesota Statutes 2014, section 144.7055, is amended to read:
144.7055 STAFFING PLAN REPORTS.
Subdivision 1.
Definitions.
(a) For the purposes of this section, the following terms
have the meanings given.
(b) "Core staffing plan" means the projected number of full-time equivalent
nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unit.
(c) "Nonmanagerial care staff" means registered nurses, licensed practical nurses,
and other health care workers, which may include but is not limited to nursing assistants,
nursing aides, patient care technicians, and patient care assistants, who perform
nonmanagerial direct patient care functions for more than 50 percent of their scheduled
hours on a given patient care unit.
(d) "Inpatient care unit" means a designated inpatient area for assigning patients and
staff for which a distinct staffing plan exists and that operates 24 hours per day, seven days
per week in a hospital setting. Inpatient care unit does not include any hospital-based
clinic, long-term care facility, or outpatient hospital department.
(e) "Staffing hours per patient day" means the number of full-time equivalent
nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
divided by the expected average number of patients upon which such assignments are based.
deleted text begin
(f) "Patient acuity tool" means a system for measuring an individual patient's need
for nursing care. This includes utilizing a professional registered nursing assessment of
patient condition to assess staffing need.
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(f) "Direct-care registered nurse" means a registered nurse, as defined in section
148.171, who is nonsupervisory and nonmanagerial and is directly providing nursing care
to patients more than 60 percent of the time.
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Subd. 2.
Hospital staffing report.
(a) The chief nursing executive or nursing
designee of every reporting hospital in Minnesota under section 144.50 will develop a
core staffing plan for each patient care unit.
(b) Core staffing plans shall specify the deleted text begin full-time equivalent for each patient care
unit for each 24-hour period.deleted text end new text begin following:
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(1) the definition of the patient care unit;
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(2) the number of beds available in each patient care unit;
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(3) the average number of patients per day in each patient care unit; and
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(4) the full-time equivalent for each patient care unit broken down by:
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(i) shift, based on eight-hour shifts of 7:00 a.m. to 3:00 p.m., 3:00 p.m. to 11:00
p.m., and 11:00 p.m. to 7:00 a.m.; and
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(ii) type of staff assigned including but not limited to registered nurses, licensed
practical nurses, certified nursing assistants, and other additional care team members.
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(c) Prior to submitting the core staffing plan, as required in subdivision 3, hospitals
shall consult deleted text begin withdeleted text end new text begin and obtain consent fromnew text end representatives of the deleted text begin hospital medical
staff, managerial and nonmanagerial care staff, and other relevant hospital personnel
aboutdeleted text end new text begin nonmanagerial care staff and all affected exclusive bargaining representatives of
nonmanagerial care staff regardingnew text end the core staffing plan and the expected average number
of patients upon which the staffing plan is based.new text begin Direct-care registered nurses must
certify the report as accurate and clearly presented by majority vote or by the exclusive
bargaining representative if represented by a collective bargaining unit.
new text end
Subd. 3.
Standard electronic reporting developed.
(a) Hospitals must submit the
core staffing plans to the Minnesota Hospital Association deleted text begin by January 1, 2014deleted text end new text begin quarterlynew text end .
The Minnesota Hospital Association shall include each reporting hospital's core staffing
plan on the Minnesota Hospital Association's Minnesota Hospital Quality Report Web site
deleted text begin by April 1, 2014deleted text end new text begin within three months of submissionnew text end . Any substantial changes to the core
staffing plan shall be updated within 30 days.
(b) The Minnesota Hospital Association shall include on its Web site for each
reporting hospital on a quarterly basis the actual direct patient care hours per patientnew text begin , per
shift, based on an eight-hour shift, based on shifts from 7:00 a.m. to 3:00 p.m., 3:00 p.m.
to 11:00 p.m., and 11:00 p.m. to 7:00 a.m.,new text end and per unit. Hospitals must submit the direct
patient care report to the Minnesota Hospital Association deleted text begin by July 1, 2014, and quarterly
thereafterdeleted text end new text begin each quarter and the Minnesota Hospital Association must post the actual direct
patient care staffing report on the hospital quality reporting Web site within three monthsnew text end .
new text begin Subd. 4. new text end
new text begin Enforcement. new text end
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(a) The commissioner shall impose a civil penalty of not
less than $25,000 for each hospital failing to comply with the provisions of this section,
including failure to report by the deadline or failure to provide information according to
the requirements of this section. Each day of the violation shall constitute a separate
violation and the penalties prescribed shall be applicable to each separate violation unless
otherwise indicated.
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(b) The commissioner must publicly report, at a minimum, on its Web site all
incidents of noncompliance with any provision within this section.
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Sec. 3.
Minnesota Statutes 2014, section 144.7065, is amended by adding a subdivision
to read:
new text begin Subd. 7b. new text end
new text begin Unsafe hospital staffing level events. new text end
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Any event that caused a need
for a patient to have an extended hospital stay or readmission and the extended stay or
readmission was caused, fully or partially, by unsafe staffing levels at the hospital, as
determined by the patient's direct-care registered nurse as of the time of the event is
reportable under this subdivision.
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Sec. 4.
Minnesota Statutes 2014, section 144.7065, is amended by adding a subdivision
to read:
new text begin Subd. 11. new text end
new text begin Safe staffing in hospitals. new text end
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The commissioner shall accept complaints
from persons employed by a hospital licensed under section 144.55 regarding safe
staffing. Complaints reported under this subdivision may be made in any form used by the
hospital or professional association or the commissioner may adopt a written or electronic
complaint process. Complaints made relating to safe staffing levels and situations of high
risk, even in the case of no adverse event, are reportable under this section.
new text end
Sec. 5.
Minnesota Statutes 2014, section 148.264, subdivision 1, is amended to read:
Subdivision 1.
Reporting.
new text begin (a) new text end Any person, health care facility, business, or
organization is immune from civil liability or criminal prosecution for submitting in good
faith a report to the board under section 148.263 or for otherwise reporting in good faith to
the board violations or alleged violations of sections 148.171 to 148.285. All such reports
are investigative data as defined in chapter 13.
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(b) Any registered nurse or health care worker who experiences and subsequently
reports a level of staffing that in the registered nurse's or health care worker's professional
judgment could reasonably be expected to result in unsafe or ineffective patient care
cannot be disciplined under section 148.261, subdivision 1, clause (8). These reports
can include a report to the registered nurse's supervisor at the supervisor's place of
employment, the Board of Nursing, the commissioner of health, or a professional nursing
organization. Reports must be made within ten calendar days of the incident in order
to be covered under this section.
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