Set Nurse-Patient Staffing Ratios

Section 1. Short title. This act shall be known and may be cited as the "safe staffing for quality care act".

§ 2. Paragraphs (a) and (b) of subdivision 2 of section 2805 of the public health law, paragraph (a) as amended by chapter 923 of the laws of 1973 and paragraph (b) as added by chapter 795 of the laws of 1965, are amended to read as follows:

(a) Application for an operating certificate for a hospital shall be made upon forms prescribed by the department. The application shall [contain] include the name of the hospital, the kind or kinds of hospital service to be provided, the location and physical description of the institution, a documented staffing plan, as defined in section twentyeight hundred twenty-eight of this article, and such other information as the department may require.

EXPLANATION--Matter in italics (underscored) is new; matter in brackets

[ ] is old law to be omitted.

LBD02902-03-7

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(b) An operating certificate shall not be issued by the department unless it finds that the premises, equipment, personnel, documented staffing plan, rules and by-laws, standards of medical care, and hospital service are fit and adequate and that the hospital will be operated in the manner required by this article and rules and regulations thereunder.

§ 3. The public health law is amended by adding nine new sections 2827, 2828, 2829, 2830, 2831, 2832, 2833, 2834 and 2835 to read as follows:

§ 2827. Policy and purpose. The legislature finds and declares all of the following:

1. Health care services are becoming complex and it is increasingly difficult for patients to access integrated services;

2. The quality of patient care is jeopardized because of nurse staffing shortages and improper utilization of nursing services;

3. To ensure the adequate protection of patients in health care settings, it is essential that qualified registered nurses and other licensed nurses be accessible and available to meet the needs of patients; and

4. The basic principles of staffing in the health care setting should be based on the patient's care needs, the severity of condition, services needed and the complexity surrounding those services.

§ 2828. Safe staffing; definitions. The following words and phrases, as used in this article, shall have the following meanings unless the context otherwise plainly requires:

1. "Acute care facility" shall mean a hospital other than a residential health care facility and shall also include any facility that provides health care services pursuant to the mental hygiene law, article nineteen-G of the executive law or the correction law if such facility is operated by the state or a political subdivision of the state or a public authority or public benefit corporation.

2. "Acuity system" shall mean an established measurement instrument which (a) predicts nursing care requirements for individual patients based on severity of patient illness, need for specialized equipment and technology, intensity of nursing interventions required, and the complexity of clinical nursing judgment needed to design, implement and evaluate the patient's nursing care plan; (b) details the amount of nursing care needed, both in number of direct-care nurses and in skill mix of nursing personnel required, on a daily basis, for each patient in a nursing department or unit; and (c) is stated in terms that readily can be used and understood by direct-care nurses. The acuity system shall take into consideration the patient care services provided not only by registered professional nurses but also by licensed practical nurses, social workers and other health care personnel.

3. "Assessment tool" shall mean a measurement system that compares the staffing level in each nursing department or unit against actual patient nursing care requirements in order to review the accuracy of an acuity system.

4. "Direct-care nurse" and "direct-care nursing staff" shall mean any nurse who has principal responsibility to oversee or carry out medical regimens, nursing or other bedside care for one or more patients.

5. "Documented staffing plan" shall mean a detailed written plan setting forth the minimum number and classification of direct-care nurses required in each nursing department or unit in an acute care facility for a given year, based on reasonable projections derived from the patient census and average acuity level within each department or unit

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during the prior year, the department or unit size and geography, the nature of services provided and any foreseeable changes in department or unit size or function during the current year.

6. "Nurse" shall mean a registered professional nurse or licensed practical nurse licensed pursuant to article one hundred thirty-nine of the education law.

7. "Nursing care" shall mean that care which is within the definition of the practice of nursing pursuant to section sixty-nine hundred two of the education law, or otherwise encompassed with the recognized standards of nursing practice, including assessment, nursing diagnosis, planning, intervention, evaluation and patient advocacy.

8. "Safe staffing requirements" shall mean the provisions of this section and sections twenty-eight hundred twenty-seven, twenty-eight hundred twenty-nine, twenty-eight hundred thirty, twenty-eight hundred thirty-one, twenty-eight hundred thirty-two, twenty-eight hundred thirty-three, twenty-eight hundred thirty-four and twenty-eight hundred thirty-five of this article and all rules and regulations adopted pursuant thereto.

9. "Skill mix" shall mean the differences in licensing, specialty and experience among direct-care nurses.

10. "Staffing level" shall mean the actual numerical nurse to patient ratio within a nursing department or unit.

11. "Unit" shall mean a patient care component, as defined by the department, within an acute care facility.

12. "Non-nursing direct-care staff" shall mean any employee who is not a nurse or other person licensed, certified or registered under title eight of the education law whose principal responsibility is to carry out patient care for one or more patients or provides direct assistance in the delivery of patient care.

§ 2829. Commissioner and council; powers and duties. The commissioner shall:

1. appoint an acute care facility council consisting of thirteen members. No less than seven members shall be registered professional nurses, three of whom shall be direct care registered nurses, three of whom shall be nurse managers and one of whom shall be a nurse administrator. No less than two members of the acute care facility council shall be representatives of recognized or certified collective bargaining agents of non-nursing direct care staff. There shall be at least two representatives of acute care facilities, one representative of a nursing professional association, and one representative of a recognized or certified bargaining agent of nurses. The acute care facility council shall advise the commissioner in the development of regulations, including registered professional nurse to patient staffing requirements and non-nursing direct-care staff to patient ratios that are not specified in this article; the efficacy of acuity systems submitted for approval by the commissioner; the development of an assessment tool used to evaluate the efficacy of acuity systems; and review and make recommendations on approval of staffing plans prior to the granting of an operating certificate by the department.

2. promulgate, after consultation with the acute care facility council, the rules and regulations necessary to carry out the purposes and provisions of the safe staffing requirements, including regulations defining terms, setting forth direct-care nurse to patient ratios, setting forth non-nursing direct-care staff to patient ratios and prescribing the process for approving facility specific acuity systems; and

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3. assure that the provisions of safe staffing requirements are enforced, including the issuance of regulations which at a minimum provide for an accessible and confidential system to report the failure to comply with such requirements and public access to information regarding reports of inspections, results, deficiencies and corrections pursuant to such requirements.

§ 2830. Staffing requirements. 1. Staffing requirements. Each acute care facility shall ensure that it is staffed in a manner that provides sufficient, appropriately qualified direct-care nurses in each department or unit within such facility in order to meet the individualized care needs of the patients therein. At a minimum, each such facility shall meet the requirements of subdivisions two and three of this section.

2. Staffing plan. The department shall not issue an operating certificate to any acute care facility unless such facility annually submits to the department a documented staffing plan and a written certification that the submitted staffing plan is sufficient to provide adequate and appropriate delivery of health care services to patients for the ensuing year. The documented staffing plan shall:

(a) meet the minimum requirements set forth in subdivision three of this section;

(b) be adequate to meet any additional requirements provided by other laws, rules or regulations;

(c) employ and identify an acuity system for addressing fluctuations in actual patient acuity levels and nursing care requirements requiring increased staffing levels above the minimums set forth in the plan;

(d) factor in other unit or department activity such as discharges, transfers and admissions, staff breaks, meals, routine and expected absences from the unit and administrative and support tasks that are expected to be done by direct-care nurses in addition to direct nursing care;

(e) include a plan to meet necessary staffing levels and services provided by non-nursing direct-care staff in meeting patient care needs pursuant to subdivision one of this section; provided, however, that the staffing plan shall not incorporate or assume that nursing care functions required by laws, rules or regulations, or accepted standards of practice to be performed by a registered professional nurse are to be performed by other personnel;

(f) identify the system that will be used to document actual staffing on a daily basis within each department or unit;

(g) include a written assessment of the accuracy of the prior year's staffing plan in light of actual staffing needs;

(h) identify each nurse staff classification referenced in such plan together with a statement setting forth minimum qualifications for each such classification; and

(i) be developed in consultation with a majority of the direct-care nurses within each department or unit or, where such nurses are represented, with the applicable recognized or certified collective bargaining representative or representatives of the direct-care nurses and of other supportive and assistive staff.

3. Minimum staffing requirements. (a) The documented staffing plan shall incorporate, at a minimum, the following direct-care nurse-to-patient ratios:

(i) one nurse to one patient: operating room and trauma emergency units and maternal/child care units for the second or third stage of labor;

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(ii) one nurse to two patients: maternal/child care units for the first stage of labor, and all critical care areas including emergency critical care and all intensive care units and postanesthesia units;

(iii) one nurse to three patients: antepartum, emergency room, pediatrics, step-down and telemetry units and units for newborns and intermediate care nursery units;

(iv) one nurse to three patients: postpartum mother/baby couplets (maximum six patients per nurse);

(v) one nurse to four patients: non-critical antepartum patients, postpartum mother only units and medical/surgical and acute care psychiatric units;

(vi) one nurse to five patients: rehabilitation units and subacute patients; and

(vii) one nurse to six patients: well-baby nursery units.

For any units not listed in this paragraph, including, but not limited to, psychiatric units, and acute care facilities operated pursuant to the mental hygiene law or the correction law, the department shall establish by regulation the appropriate direct-care nurse-to-patient ratio.

(b) The nurse-to-patient ratios set forth in paragraph (a) of this subdivision shall reflect the maximum number of patients that may be assigned to each direct-care nurse in a unit at any one time.

(c) There shall be no averaging of the number of patients and the total number of nurses on the unit during any one shift nor over any period of time.

(d) The commissioner, in consultation with the acute care facility council, shall establish regulations providing for the maintenance of minimum nurse-to-patient ratios, as set forth in this section, including during routine or expected absences from the unit, such as meals or breaks.