SENATE BILL No. 228

 

 

February 27, 2013, Introduced by Senators WARREN, HOPGOOD, HUNE, HOOD, SMITH and YOUNG 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 after that, a hospital, state-owned hospital,

 

or state-owned facility shall submit to the department a staffing

 

plan as provided under this section. Each hospital, state-owned

 

hospital, or state-owned facility shall develop and implement a

 

written staffing plan that provides sufficient, appropriately

 

qualified nursing staff in each unit within the hospital, state-

 

owned hospital, or state-owned facility in order to meet the

 

individualized needs of its patients. Each hospital, state-owned

 

hospital, or state-owned facility shall develop an assessment tool

 


that evaluates the actual patient acuity levels and nursing care

 

requirements for each unit during each shift. The hospital, state-

 

owned hospital, or state-owned facility 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, the

 

hospital, state-owned hospital, or state-owned facility 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, state-

 

owned hospital, or state-owned facility 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, state-owned hospital, or state-owned facility

 

shall not retaliate against a nurse who participates on the

 

staffing committee. The staffing committee shall establish a

 

staffing strategy for that unit if the patients' needs within that

 

unit for a shift exceeds the required minimum direct care

 

registered professional nurse-to-patient ratios set forth in

 

subsection (4).

 

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

 

each hospital, state-owned hospital, or state-owned facility 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 in subsection (4). The assessment tool shall be used

 

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

 

staffing plan of a hospital, state-owned hospital, or state-owned

 

facility 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 patient: 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 in this subsection, in

 

computing the registered professional nurse-to-patient ratio

 

required under subsection (4), the hospital, state-owned hospital,

 

or state-owned facility 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, state-owned hospital, or state-

 

owned facility 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 unforeseen emergent situation

 

exists. In computing the registered professional nurse-to-patient

 

ratio for the operating room, the hospital, state-owned hospital,

 

or state-owned facility 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) The hospital, state-owned hospital, or state-owned

 

facility shall post the staffing plan of the hospital, state-owned

 

hospital, or state-owned facility for each unit in a conspicuous

 


place within that unit for public review. Upon request, the

 

hospital, state-owned hospital, or state-owned facility shall

 

provide copies of the staffing plan that are filed with the

 

department to the public. The hospital, state-owned hospital, or

 

state-owned facility 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 acuity system or assessment tool of the hospital, state-owned

 

hospital, or state-owned facility. A hospital, state-owned

 

hospital, or state-owned facility 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, state-owned hospital, or state-owned facility

 

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 acuity system or assessment tool of the

 

hospital, state-owned hospital, or state-owned facility to maintain

 

safe patient care, is in violation of this section. Each violation

 

shall be reported to the department by the designated

 

representative of the hospital, state-owned hospital, or state-

 

owned facility, and 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.