Enacts the "safe staffing for quality care act"

Summary of provisions

Section 1 is the short title.

Section 2 amends Public Health Law § 2805 to require that application for operating certificates for a hospital include a direct care staffing plan.

Section 3 adds nine new sections, 2823 through 2531, which require hospitals to maintain and comply with a. staffing. plan; establish the Acute Care facility Council to be appointed by the Commissioner of Health, enumerate the elements of a satisfactory staffing, plan; set forth minimum nurse to patient ratios; require clinical competency: provide for emergency situations; require public disclosure of facility staffing requirements: and allows for private right of action by employees.

Section 4 amends § 2801-a directing the Public Health and Health Planning Council to consider staffing violations when reviewing "character, competence and standing in the community" for applications and renewals of certificates of incorporation or establishment of a hospital.

Section 5 amends § 2805 requiring the Commissioner to consider staffing violations when reviewing applications and renewals operating certificates for acute care facilities.

Section 6 amends § 2895-b to establish a Residential Health Care Facility Council to be appointed by the Commissioner; requires minimum staff hours of care per resident per day; allows for private right of action by employees: and requires public disclosure of information about direct care staffing.

Justification

The hospital nurse-to-patient ratios specified in this bill are based on peer-reviewed academic research and evidence-based recommendations. The minimum care hours specified for residential health care facilities are also based on research evidence and on the recommendations of the Institute of Medicine's report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" (2004).

The number of patients assigned to a nurse has a direct impact on the quality of care that nurse can provide. Research published in the Journal of the American Medical Association, estimates five additional deaths per 1,000 patients in hospitals which routinely staff with only

1:8 nurse-to-patient ratios compared to those staffing with 1:4 nurse to-patient ratios. This same study determined the odds of patient death increased by 7% for each additional patient the nurse must care for at one time.

Safe nurse staffing also reduces avoidable, adverse patient outcomes. Research funded by the federal Agency for Healthcare Research and Quality (AHRQ) has demonstrated that hospitals with lower nurse staffing levels have higher rates of pneumonia, shock, cardiac arrest, urinary tract infections and upper gastrointestinal bleeds; all leading to higher costs and mortality from hospital-acquired complications.

In nursing homes, research has demonstrated that safe nurse staffing levels have a positive impact on facility processes and on resident outcomes. Research has demonstrated that as nurse turnover increases in nursing homes, the quality of resident care declines, resulting in more frequent use of restraints, urinary catheterization, and psychoactive drugs; increased risk of contractures, pressure ulcers and more survey deficiencies.

A broad range of research demonstrates that increased staffing levels do not diminish the profitability of facilities. Nursing workforce costs may rise, but that increase is mitigated by overall savings from improved patient outcomes and avoided adverse events. The improved outcomes reduce medical malpractice and other penalties resulting from avoidable occurrences and poor patient satisfaction.

In 2004, California became the first state to mandate nurse staffing ratios in hospitals. New statistical analysis reveals that the California mandates are significantly associated with fewer negative outcomes for patients and staff. The study, published in Health Services Research and conducted by the Center for Health Outcomes and Policy Research, University of Pennsylvania, concluded that "improved muse staffing, however it is achieved, is associated with better outcomes for nurses and patients."

Establishing staffing standards for nursing and unlicensed direct care staff in acute care facilities and residential health care facilities will help ensure that these facilities operate in a manner that guarantees the public safety and the delivery of quality health care services.

Legislative history

2012: S.4553 (similar) died in Health

Fiscal implications

Some staff time in the Department of Health; possible increased Medicaid spending to cover the cost of increased staffing balanced by reduced Medicaid spending as reduced bad outcomes and reduced staff turnover reduce health care costs.

Effective date

Takes effect 180 days after it becomes law.