March 14, 2012, Introduced by Senators WARREN, YOUNG, HOPGOOD, SMITH, HOOD and GLEASON and referred to the Committee on Health Policy.




     A bill to amend 1978 PA 368, entitled


"Public health code,"


(MCL 333.1101 to 333.25211) by adding section 21525.




     Sec. 21525. (1) Within 1 year after the effective date of this


section and annually thereafter, a hospital shall submit to the


department a staffing plan as provided under this section. A


hospital shall develop and implement a written staffing plan that


provides sufficient, appropriately qualified nursing staff in each


unit within the hospital in order to meet the individualized needs


of its patients. A hospital shall develop an assessment tool that


evaluates the actual patient acuity levels and nursing care


requirements for each unit during each shift. The hospital shall


use the assessment tool to make adjustments to the staffing plan as


needed to ensure safe patient care.


     (2) To assist in the development of a staffing plan, a


hospital shall establish a staffing committee for each unit and at


least 1/2 of the members shall be registered professional nurses


who are direct care providers in that unit. If the nurses in the


hospital are under a collective bargaining agreement, the


collective bargaining representative shall designate the nurses


from within each unit to serve on the staffing committee for that


unit. Participation on the staffing committee is considered a part


of the nurse's regularly scheduled workweek. A hospital shall not


retaliate against a nurse who participates on the staffing


committee. The staffing committee shall establish a staffing


strategy for a unit if the patients' needs within that unit during


a shift exceed the required minimum direct care registered


professional nurse-to-patient ratios set forth under subsection




     (3) Within 2 years after the effective date of this section, a


hospital shall establish and implement an acuity system for


addressing fluctuations in actual patient acuity levels and nursing


care requirements requiring increased staffing levels above the


minimums set forth under subsection (4). The hospital shall use the


assessment tool annually to review the accuracy of the acuity


system established under this subsection.


     (4) Within 3 years after the effective date of this section, a


hospital's staffing plan shall incorporate, at a minimum, the


following direct care registered professional nurse-to-patient


ratios for each of the corresponding units:


     (a) Critical care - adult or pediatric: 1 to 1.


     (b) Operating room: 1 to 1.


     (c) Labor and delivery:


     (i) During second and third stages of labor: 1 to 1.


     (ii) During first stage of labor: 1 to 2.


     (iii) Intermediate care newborn nursery: 1 to 3.


     (iv) Noncritical antepartum patients: 1 to 4.


     (v) Postpartum mother baby couplet: 1 to 3.


     (vi) Postpartum or well-baby care: 1 to 6.


     (d) Postanesthesia care unit: 1 to 2.


     (e) Emergency department:


     (i) Nontrauma or noncritical care: 1 to 3.


     (ii) Trauma or critical care: 1 to 1.


     (iii) One r.n. for triage.


     (f) Stepdown: 1 to 3.


     (g) Telemetry: 1 to 3.


     (h) Medical/surgical: 1 to 4.


     (i) Pediatrics: 1 to 4.


     (j) Behavioral health: 1 to 4.


     (k) Rehabilitation care: 1 to 5.


     (5) Except as otherwise provided under this subsection, in


computing the registered professional nurse-to-patient ratio


required under subsection (4), a hospital shall not include a


registered professional nurse who is not assigned to provide direct


patient care in that unit or who is not oriented, qualified, and


competent to provide safe patient care in that unit. In the event


of an unforeseen emergent situation, a hospital may include a staff


member who is a registered professional nurse who is not normally


used in computing the ratio requirement because the staff member


performs primarily administrative functions if the staff member


provides direct patient care during the emergency, but shall be


included in the computation only for as long as the emergent


situation exists. In computing the registered professional nurse-


to-patient ratio for the operating room, the hospital shall not


include a circulating r.n. or a first assistant r.n.


     (6) The registered professional nurse-to-patient ratio


established for each unit under subsection (4) does not limit,


reduce, or otherwise affect the need for other licensed or


unlicensed health care professionals, assistants, or support


personnel necessary to provide safe patient care within the unit.


     (7) A hospital shall post the hospital's staffing plan for


each unit in a conspicuous place within that unit for public


review. Upon request, the hospital shall provide copies of the


staffing plan that are filed with the department to the public. The


hospital shall make available for each member of the nursing staff


a copy of the staffing plan for his or her unit, including the


number of direct care registered professional nurses required for


each shift and the names of those registered professional nurses


assigned and present during each shift. A staffing plan developed


under this section and the minimum staffing ratios established


under this section are minimums and shall be increased as needed to


provide safe patient care as determined by the hospital's acuity


system or assessment tool. A hospital shall not use mandatory


overtime as a staffing strategy in the delivery of safe patient


care except in the event of an unforeseen emergent situation.


     (8) A hospital that fails to submit an annual staffing plan as


required under this section or that does not meet the required


staffing plan established for each unit during each shift, as


adjusted in accordance with the hospital's acuity system or


assessment tool to maintain safe patient care, is in violation of


this section. The hospital's designated representative shall report


each violation to the department. The department shall assess an


administrative fine of up to $10,000.00 for each violation. Each


day that the staffing plan is not filed and each shift that does


not satisfy the minimum staffing requirements for that unit is a


separate violation. The department shall take into account each


violation of this section when making licensure decisions.


     (9) The fines assessed under this section shall be deposited


into the nurse professional fund established under section 16315


and expended only for the operation and administration of the


Michigan nursing scholarship program established under the Michigan


nursing scholarship act, 2002 PA 591, MCL 390.1181 to 390.1189.


     (10) As used in this section:


     (a) "Acuity system" means a system established to measure


patient needs and nursing care requirements for each unit to ensure


safe patient care based upon the severity of each patient's illness


and need for specialized equipment and technology, the intensity of


nursing interventions required for each patient, and the complexity


of the clinical nursing judgment needed to design, implement, and


evaluate each patient's care plan.


     (b) "Department" means the department of community health.


     (c) "Mandatory overtime" means a mandated assignment for a


registered professional nurse to work more than his or her


regularly scheduled hours according to his or her predetermined


work schedule.


     (d) "Registered professional nurse" or "r.n." means that term


as defined in section 17201.


     (e) "Staffing plan" means a written plan that establishes the


minimum specific number of registered professional nurses required


to be present in each unit for each shift to ensure safe patient




     (f) "Unforeseen emergent situation" means an unusual or


unpredictable circumstance that increases the need for patient care


including, but not limited to, an act of terrorism, a disease


outbreak, adverse weather conditions, or a natural disaster.