SENATE BILL No. 1019

 

 

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.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     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

 

(4).

 

     (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

 

care.

 

     (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.