SF 471

as introduced - 88th Legislature (2013 - 2014) Posted on 03/21/2013 01:10pm

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; proposing
coding for new law in Minnesota Statutes, chapter 144.

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

Section 1.

new text begin [144.591] STANDARDS OF CARE ACT.
new text end

new text begin Subdivision 1. new text end

new text begin Title. new text end

new text begin This section may be cited as the "Standards of Care Act."
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following terms have the
meanings given:
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new text begin (a) "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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new text begin (b) "Direct care registered nurse" means a registered nurse, as defined in section
148.171, who is directly providing nursing care to patients.
new text end

new text begin (c) "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.
new text end

new text begin (d) "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.
new text end

new text begin (e) "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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new text begin (f) "Surveillance" means the continuous process of observing patients for early
detection and intervention in an effort to prevent negative patient outcomes.
new text end

new text begin (g) "Unit" means an area or location of a hospital where patients receive care based
on similar patient acuity and nursing intensity.
new text end

new text begin Subd. 3. new text end

new text begin Staffing. new text end

new text begin (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,
including, but not limited to, the following:
new text end

new text begin (1) Association of Women's Health, Obstetric and Neonatal Nurses;
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new text begin (2) Association of Operating Room Nurses;
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new text begin (3) Emergency Nurses Association; and
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new text begin (4) American Association of Critical Care Nurses.
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new text begin (b) In the absence of an evidence-based standard established for a specific
hospital care unit as provided in paragraph (a), a working group must be created by the
commissioner to review evidence-based research and develop a standard. The working
group must be staffed by the commissioner or the commissioner's designee and must
include, but is not limited to, the following members appointed by the governor:
new text end

new text begin (1) one member who represents the Minnesota Hospital Association;
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new text begin (2) one member who represents the Minnesota Nurses Association;
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new text begin (3) two members of the public;
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new text begin (4) two members who are registered nurses and represent greater Minnesota;
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new text begin (5) two members who are registered nurses and represent the metropolitan area;
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new text begin (6) two members who are registered nurses and represent hospitals licensed for
25 beds or less; and
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new text begin (7) two members who are registered nurses and represent hospitals licensed for
more than 25 beds.
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new text begin Costs incurred for staffing and managing this working group shall be paid for with hospital
licensing fees.
new text end

new text begin Subd. 4. new text end

new text begin Assignment adjustments. new text end

new text begin (a) Hospitals must assign nursing personnel
to each patient care unit consistent with nationally accepted nursing clinical standards.
If a direct care registered nurse determines, based on the nurse's professional judgment,
that adjustments in staffing levels are required due to patient acuity and nursing intensity,
then shift-to-shift adjustments in staffing levels must be made according to procedures
developed by the Safe Patient Assignment Committee, established pursuant to subdivision
5. Hospitals must not use mandatory overtime as a means to meet staffing standards.
new text end

new text begin (b) A direct care registered nurse may not be disciplined for refusing to accept an
assignment if, in good faith and in the nurse's professional judgment, the nurse determines
that the assignment is unsafe for patients due to patient acuity and nursing intensity.
new text end

new text begin Subd. 5. new text end

new text begin Safe Patient Assignment Committee. new text end

new text begin (a) By July 1, 2014, 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.
new text end

new text begin (b) Membership of the committee must include, but is not limited to, the following
members:
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new text begin (1) at least 60 percent of the membership must be registered nurses who provide
direct patient care; and
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new text begin (2) collective bargaining-appointed members to proportionately represent its nurses.
new text end

new text begin Hospitals must compensate registered nurses who are employed by the hospital and serve on
the staffing for Safe Patient Assignment Committee for time spent on committee business.
new text end

new text begin (c) Safe Patient Assignment Committees shall:
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new text begin (1) complete a staffing for patient safety assessment by March 31, 2014, and
annually thereafter that identifies the following:
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new text begin (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;
new text end

new text begin (ii) units that pose the highest risk to patient safety due to inadequate staffing; and
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new text begin (iii) solutions for problems identified under items (i) and (ii);
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new text begin (2) implement and evaluate staffing standards provided in subdivision 3;
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new text begin (3) convert national standards described in subdivision 3 into registered nurse hours
of care per patient;
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new text begin (4) recommend a mechanism for tracking and analyzing staffing trends within the
hospital;
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new text begin (5) develop a procedure for making shift-to-shift adjustments in staffing levels when
such adjustments are required by patient acuity and nursing intensity; and
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new text begin (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 Posting staffing levels. new text end

new text begin (a) Staffing levels for each unit must be
conspicuously posted in each unit and in waiting areas. The postings must be visible
to hospital staff, patients, and the public.
new text end

new text begin (b) The commissioner must post on the Department of Health's Web site the
standards for each unit as defined under subdivision 3.
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new text begin Subd. 7. new text end

new text begin Reporting. new text end

new text begin Hospitals must publicly report hours-per-patient direct care
that registered nurses spend per patient on all patient care units. The first report is due
March 31, 2014, and quarterly thereafter. The report must include actual hours worked by
registered nurses per patient, not scheduled hours. This report must be submitted to the
commissioner and posted on the hospital's Web site and on the Department of Health's
Web site. This report must be titled the "Real Time RN Staffing Report." Beginning
March 31, 2015, hospitals must publicly report patient outcomes relative to actual hours
worked by registered nurses per patient.
new text end

new text begin Subd. 8. new text end

new text begin Enforcement. new text end

new text begin The commissioner may sanction a hospital for failure to
comply with the provisions of this section, including failure to staff patient care units
at required levels.
new text end