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Minnesota Legislature

Office of the Revisor of Statutes

SF 2742

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to health; requiring hospitals to develop staffing levels for direct
care registered nurses; amending Minnesota Statutes 2006, section 144.7067,
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.

new text begin [144.591] REGISTERED NURSE STAFFING FOR PATIENT SAFETY.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

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.
new text end

new text begin (b) "Assignment limit" means the maximum number of patients for whom one
direct care registered nurse can be responsible during a shift. Assignment limits may
vary by nursing unit.
new text end

new text begin (c) "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 (d) "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 (e) "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 (f) "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.
new text end

new text begin (g) "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 (h) "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. 2. new text end

new text begin Staffing plan. new text end

new text begin (a) By July 1, 2009, all hospitals licensed under section
144.55 shall adopt and implement a staffing plan that sets out the maximum number of
patients that may be assigned to a direct care registered nurse for each unit of the hospital
in order to ensure adequate staffing levels for patient safety. Staffing plans adopted and
implemented under this section shall establish staffing levels that include the flexibility
to increase the number of nurses required for a unit when necessary for patient safety.
The staffing plans must be developed in agreement with direct care registered nurses
and must comply with the requirements in subdivision 3. The staffing plans developed
under this section must require that direct care registered nurses be assigned less patients
than provided in subdivision 3 if the Staffing for Patient Safety Committee defined in
subdivision 5 determines lower assignment limits are necessary for patient safety based on
the following additional considerations:
new text end

new text begin (1) results of the assessment performed by the Staffing for Patient Safety Committee,
as required in subdivision 5, paragraph (c);
new text end

new text begin (2) the number of patients in each unit, the acuity of patients, and the level and
variation in the nursing intensity needed for patients;
new text end

new text begin (3) anticipated admissions, discharges, and transfers of patients during each shift;
new text end

new text begin (4) specialized experience or knowledge required of direct care registered nurses
for a particular unit;
new text end

new text begin (5) the skill mix of regularly scheduled direct care registered nurses, licensed
practical nurses, and unlicensed nursing personnel;
new text end

new text begin (6) staffing levels, availability, and services provided by other health care personnel
who provide direct patient care, including ancillary and temporary staff;
new text end

new text begin (7) work environment factors that affect staffing needs and the delivery of care
including, but not limited to, building architecture and layout, available technology, and
staff familiarity with hospital practices and policies;
new text end

new text begin (8) relevant national nursing and specialty organizations' standards for staffing; and
new text end

new text begin (9) nursing-sensitive quality outcomes.
new text end

new text begin (b) Staffing plans must include staffing levels as developed by the Staffing for
Patient Safety Committee for specialty units including, but not limited to, procedural,
observation, bariatric, interventional radiology, and electrophysiology units. Staffing for
Patient Safety Committees must use the considerations stated in paragraph (a), clauses (1)
to (9), to develop staffing levels for specialty units.
new text end

new text begin (c) In addition to the requirements in paragraph (a), hospital staffing plans must
include the information gathered and developed in accordance with subdivision 5,
paragraph (c), clauses (1) to (4).
new text end

new text begin (d) Compliance with staffing levels for direct care registered nurses does not
permit a hospital to inadequately staff other health care workers including, but not
limited to, licensed practical nurses, unlicensed assistive personnel, respiratory therapists,
occupational therapists, physical therapists, and health unit coordinators.
new text end

new text begin (e) By July 1, 2009, every hospital licensed in the state must submit its staffing
plan to the commissioner.
new text end

new text begin Subd. 3. new text end

new text begin Assignment limits for direct care registered nurses. new text end

new text begin (a) Staffing plans
developed under subdivision 2 may not permit direct care registered nurses to be assigned
more patients than the following for any shift:
new text end

new text begin (1) one registered nurse to one patient in operating rooms, trauma units, for patients
in the second and third stages of labor, and for unstable patients requiring transfer to
another unit;
new text end

new text begin (2) one registered nurse to two patients in postanesthesia care units and critical care
units, and for patients in the first stage of labor;
new text end

new text begin (3) one registered nurse to three patients in intermediate care newborn nurseries,
telemetry units, and emergency departments;
new text end

new text begin (4) one registered nurse to four patients in medical and surgical units, pediatric units,
and for noncritical antepartum patients;
new text end

new text begin (5) one registered nurse to five patients for rehabilitation care units and acute
psychiatric mental health or chemical dependency units; and
new text end

new text begin (6) one registered nurse to six patients, or three couplets, in uncomplicated
postpartum or routine well-baby units.
new text end

new text begin (b) The registered nurse staffing levels represent the maximum number of patients to
which a direct care registered nurse may be assigned at all points during a shift and is not
an average number of patients to a total number of nurses on a unit during a shift.
new text end

new text begin (c) Nothing in this section requires a hospital with lower patient assignment limits
than those set out in clauses (1) to (6) to increase its assignment limits.
new text end

new text begin (d) Nothing in this section limits the rights of organized nurses to bargain on the
issue of assignment limits.
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 in accordance with its staffing plan. 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 in accordance with the procedure developed by the Staffing
for Patient Safety Committee.
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 RN Staffing for Patient Safety Committee. new text end

new text begin (a) By July 1, 2008, every
hospital licensed in the state must establish an RN Staffing for Patient Safety 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:
new text end

new text begin (1) at least half of the membership must be registered nurses who provide direct
patient care; and
new text end

new text begin (2) union-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 Patient Safety Committee for time spent on committee business.
new text end

new text begin (c) Staffing for Patient Safety Committees shall:
new text end

new text begin (1) complete a staffing for patient safety assessment, by December 1, 2008, that
identifies the following:
new text end

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
new text end

new text begin (iii) solutions for problems identified under clauses (i) and (ii);
new text end

new text begin (2) develop staffing levels for each unit of the hospital that meet the requirements
set out in subdivisions 2 and 3;
new text end

new text begin (3) recommend a mechanism for tracking and analyzing staffing trends within the
hospital;
new text end

new text begin (4) develop a procedure for making shift-to-shift adjustments in staffing levels when
such adjustments are required by patient acuity and nursing intensity; and
new text end

new text begin (5) conduct evaluations, at least semiannually, of staffing plans and progress toward
goals established in the policy and submit any changes made to staffing levels to the
commissioner.
new text end

new text begin Subd. 6. new text end

new text begin Posting staffing levels. new text end

new text begin Once developed, the 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 Subd. 7. new text end

new text begin Enforcement. new text end

new text begin (a) If a hospital fails to develop and submit its staffing
plan to the commissioner, the commissioner may suspend, revoke, fail to renew, or place
conditions on the hospital's license to operate.
new text end

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

Sec. 2.

Minnesota Statutes 2006, section 144.7067, subdivision 1, is amended to read:


Subdivision 1.

Establishment of reporting system.

(a) The commissioner
shall establish an adverse health event reporting system designed to facilitate quality
improvement in the health care system. The reporting system shall not be designed to
punish errors by health care practitioners or health care facility employees.

(b) The reporting system shall consist of:

(1) mandatory reporting by facilities of 27 adverse health care events;

(2) mandatory completion of a root cause analysis and a corrective action plannew text begin for
each adverse event
new text end by the facility and reporting of the findings of the analysis and the plan
to the commissioner or reporting of reasons for not taking corrective action;

(3) new text beginmandatory reporting by facilities of staffing levels in the unit where the adverse
event occurred and analysis of whether staffing levels were inadequate for patient safety;
new text end

new text begin (4) mandatory reporting of nursing-sensitive quality outcomes, including incidence
of falls, prevalence of stages one and two pressure ulcers, incidence of medication errors,
hospital-acquired urinary tract infections, hospital-acquired pneumonia, failure to prevent
clinically severe deterioration of a patient's condition during hospitalization, and analysis
of whether staffing levels were inadequate for patient safety at the time of the incident;
new text end

new text begin (5) new text endanalysis of reported information by the commissioner to determine patterns of
systemic failure in the health care system and successful methods to correct these failures;

deleted text begin (4)deleted text endnew text begin (6)new text end sanctions against facilities for failure to comply with reporting system
requirements; and

deleted text begin (5)deleted text endnew text begin (7)new text end communication from the commissioner to facilities, health care purchasers,
and the public to maximize the use of the reporting system to improve health care quality.

(c) The commissioner is not authorized to select from or between competing
alternate acceptable medical practices.

Sec. 3. new text beginNURSING AND QUALITY PATIENT OUTCOMES STUDY.
new text end

new text begin The commissioner of health, in consultation with hospitals, the Minnesota Board
of Nursing, and the Minnesota Nurses Association, shall study how nursing care should
be identified and reimbursed in hospital cost reports to more adequately reflect nurses'
contributions to quality patient outcomes.
new text end