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Nursing Laws by States. 1. California Law Definition Current status Main characteristics Nurse Staffing Standards for Patient Safety and Quality Care Act of 2013 (H.R. 1907) • Federal nurse-patient staffing ratios in all hospitals • Restrict mandatory RN overtime to emergencies • Sponsor: Rep Schakowsky, Janice D. [IL-9] (introduced 5/9/2013) 38 Cosponsors • Related Bill: S. 739 • Latest Major Action: 6/3/2013 Referred to House subcommittee. • Status: Referred to Subcommittee on Health. Direct-care RNs may be assigned to patients ranging from 1 (trauma) to 6 (postpartum), depending on the immediacy and severity of the need. Health Systems and Policy Research ISSN 2254-9137 Vol.5 No.1:67 2018 2 This article is available from: http://www.hsprj.com/ California Nurse-to-Patient Ratio Law A.B. 394, 1999-2000 Reg. Sess. (Cal. 1999). • Mandating minimum licensed nurse-patient ratios • Licensed nurses include RNs, LVNs/ LPNs • Enacted • Hospitals must meet fixed nurse-patient ratios ranging from 2:1 (intensive care) to 6:1 (psychiatric units) • Hospitals must comply with the law, yielding no negative impact. Actively licensed RNs increased by 60,000 (60%) enabling hospitals to easily meet the standard. Patient-care quality remained the same; but lower mortality and better nurse retention resulted. 2. New York Law Definition Current status Main characteristics Safe staffing for quality care act S3691A-2013 • Acute-care facilities and nursing homes implement direct-care nurse-patient ratios in all units; set minimum staffing requirements; annual documented staffing plans; acutecare facilities maintain staffing records; authorized nurses to refuse work assignments beyond their abilities or if minimum staffing is not present; required public access to plans; imposed civil penalties for violations; established private right of action for nurses refusing illegal work assignments. • Nurse ratios established by unit; violators face prosecution; staffing for acuity, as patient needs dictate; Hospitals cannot count assistive personnel toward ratios and must provide sufficient assistive personnel. Must disclose staffing levels publicly; hospital may not average staff (staffing ratios are minimums); floating nurses must demonstrate competence and have undergone orientation in the clinical area. Nurse to Patient Ratios Trauma emergency 1:1,Operating room 1:1 All intensive care 1:2, Emergency critical care 1:2 Post anesthesia care 1:2, Labor-1st stage 1:2 Labor-2nd& 3rd stage 1:1, Antepartum 1:3 Non-critical antepartum 1:4, Newborn nursery 1:3 Intermediate care nursery 1:3, Post-partum couplets 1:3 Post-partum mother-only 1:4, Well-baby nursery 1:6 Emergency department 1:3, Step-down & telemetry 1:3 Pediatrics 1:3, Medical-surgical 1:4 Acuter care psychiatric 1:4, Habilitation &sub-acute 1:5 • In nursing homes, minimum care hours per resident per day for RNs (0.75, divided among shifts), LPNs (1.3) and CNAs (2.8). Safe Staffing for Hospital Care Act Bill S. 1634-2013 • Minimum staffing levels for healthcare workers in various healthcare facilities; staffing pans; no mandatory overtime. • 2013, died in committee; 2014 • referred to health committee, 2015 • Pending Senate Health Committee • Facilities must identify assessment tools documenting daily staffing; assess last year’s staffing plan; and recognize the staff grouping system with qualifications, established with input from direct-care nursing staff or permitted collective-bargaining representative. • Defines minimum direct-care nurse-patient ratios. • Requires regulations on minimum nurse-patient ratios. When additional staffs are needed, must staff at the higher level. Skill mix must ensure specific elements. • RN must be 50% of direct-care nurses. No unlicensed personnel may perform duties limited to licensed personnel. • Facilities must be staffed at all times, and may staff at higher ratios than required. • RNs must be appropriately licensed, receive appropriate orientation, and verify competence. • Facilities maintain accurate records per diem • Forbids obligatory overtime except throughout emergencies situations acknowledged by the Governor. Limits work hours and requires off-duty hours. • Overtime is allowed if agreed in collective bargaining, with adequate measurement to avoid burnout of staff. • Facilities must accept and distribute written policies about when direct-care registered nurses may refuse a work assignment and cannot penalize employees who act in good faith to refuse a work assignment. • People injured in violation of this article are protected. • The Commissioner of Health adopts and enforces rules on compliance. • Healthcare facilities must comply; pay reasonable attorney’s and expert fees, and other costs regarding an action. 3.
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