BillCam

SENATE BILL No. 159

February 28, 2019, Introduced by Senators MCBROOM, MOSS, BRINKS, MCMORROW, WOJNO, POLEHANKI, IRWIN, MACDONALD, OUTMAN, BAYER, CHANG and RUNESTAD and referred to the Committee on Health Policy and Human Services.

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) A hospital shall provide sufficient and

qualified registered professional nursing staff at all times to

ensure patient safety.

(2) Not later than 3 years after the effective date of the

amendatory act that added this section, or not later than 4 years

if a hospital is located in a rural area, a hospital shall develop

and implement a staffing plan as provided under this section.

Within the applicable time period prescribed in this subsection and

annually after that, a hospital shall submit its staffing plan to

the department.

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

hospital shall establish a staffing committee for each unit within

the hospital and not less than 1/2 of the members must 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 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 that unit if the patients'

needs within that unit for a shift exceed the required minimum

direct care registered professional nurse-to-patient ratios set

forth in subsection (4).

(4) A hospital's staffing plan must not assign more patients

per direct care registered professional nurse than indicated by the

following direct care registered professional nurse-to-patient

ratios for each of the corresponding units:

(a) Intensive/critical care: 1 to 1.

(b) Operating room: 1 to 1, if not less than 1 additional

individual serves as a scrub assistant in the unit.

(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 mother 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) Plus 1 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) If a unit that is not listed in subsection (4) provides a

level of care to patients whose needs are similar to the needs of

patients cared for in a unit that is listed in subsection (4), a

hospital shall apply the minimum direct care registered

professional nurse-to-patient ratio for the unit that is listed in

subsection (4) to the unit that is not listed.

(6) The minimum direct care registered professional nurse-to-

patient ratios required under subsection (4) must be in effect at

all times, including during breaks, meals, and other routine,

expected absences from a unit.

(7) A hospital shall not do any of the following:

(a) In computing the minimum direct care registered

professional nurse-to-patient ratio required under subsection (4),

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.

(b) Average the number of patients and the total number of

direct care registered professional nurses assigned to patients in

a unit during 1 shift or over a period of time to meet the minimum

direct care registered nurse-to-patient ratios required under

subsection (4).

mandatory overtime to meet the minimum direct care registered

professional nurse-to-patient ratios required under subsection (4).

(8) During a shift, a hospital may decrease the number of

patients per direct care registered professional nurse below what

is indicated in the ratio required for a unit under subsection (4)

if the hospital considers it appropriate after considering the

following factors and after consulting with the direct care

registered professional nurses in the unit on that shift:

(a) The number of patients in the unit and acuity level of

those patients as determined by applying the hospital's acuity tool

on a shift-by-shift basis.

(b) The anticipated admissions, discharges, and transfers of

patients in the unit during each shift that affects direct patient

care.

professional nurses in the unit.

(d) Staffing levels and services provided by licensed

practical nurses or other ancillary staff in meeting direct patient

care needs that are not required to be met by a direct care

registered professional nurse.

(e) The level of technology available that affects the

delivery of direct patient care.

(f) The level of familiarity with hospital practices,

policies, and procedures used during a shift by a direct care

registered professional nurse who is employed by an outside agency.

(g) Obstacles to the efficient delivery of patient care caused

by the physical layout of the unit or the hospital.

(9) The minimum direct care 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.

(10) Not later than 5 years after the effective date of the

amendatory act that added this section and annually after that, the

staffing committees established under subsection (3) shall evaluate

the hospital's staffing plan in relation to actual patient care

requirements and the application of the hospital's acuity tool. A

hospital shall update its staffing plan to the extent appropriate

based on the staffing committees' evaluation.

(11) A hospital shall post in each unit a notice in a form

approved by the department. The notice must be located in a visible

and conspicuous location that is accessible to hospital staff,

patients, and the public. The notice must contain all of the

following information:

(a) The requirements of this section.

(b) An explanation of the rights of direct care registered

professional nurses, patients, and other individuals under this

section.

nurse, patient, or other individual may file a complaint with the

department against a hospital that the direct care registered

professional nurse, patient, or other individual believes has

violated this section.

(d) Instructions on how to file a complaint with the

department for a violation of this section.

(12) The department shall establish and maintain a toll-free

telephone number to provide information regarding the minimum

direct care registered professional nurse-to-patient ratios under

subsection (4) and to receive complaints alleging violations of

this section. A hospital shall provide the toll-free telephone

number to each patient admitted to the hospital for inpatient care

and inform each patient that the toll-free telephone number may be

used to file a complaint alleging a violation of this section.

(13) A direct care registered professional nurse, a patient,

or another individual may file a complaint with the department

against a hospital that the direct care registered professional

nurse, patient, or other individual believes has violated this

section. The department shall investigate each complaint received

in the manner provided for investigating written complaints under

section 20176. In addition to the protections under sections 20176a

and 20180, as applicable, an individual who files a complaint with

the department is protected under the whistleblowers' protection

act, 1980 PA 469, MCL 15.361 to 15.369.

(14) 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 is in

violation of this section. Each day that the staffing plan is not

filed with the department and each shift that does not satisfy the

minimum staffing requirement for that shift is a separate

violation. If the department determines that a hospital has failed

to submit an annual staffing plan as required under this section or

does not meet the required staffing plan established for each unit

during each shift, the department shall require the hospital to

establish a corrective action plan to prevent the recurrence of the

violation and assess an administrative fine of not less than

$10,000.00 or more than $25,000.00 for each violation or, if the

hospital has shown a pattern of violations, not less than

$25,000.00 or more than $50,000.00.

(15) The department shall publish on its website the names of

the hospitals on which an administrative fine has been imposed

under subsection (14), the violation for which the fine was

imposed, and any additional information that the department

considers appropriate. The department shall consider each violation

by a hospital under subsection (14) when making licensure

decisions.

(16) An administrative fine associated with a violation that

is collected by the department under subsection (14) must be

retained by the department and used pursuant to legislative

appropriation for the administration of this section.

(17) The department shall promulgate rules to implement this

section.

(18) As used in this section:

(a) "Acuity tool" means a system for addressing fluctuations

in patient acuity levels and assessing necessary nursing care for

each unit to ensure safe patient care based on 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) "Licensed practical nurse" means an individual licensed to

engage in the practice of nursing as a licensed practical nurse as

defined in section 17201.

direct care registered professional nurse to work more than his or

her regularly scheduled hours according to his or her predetermined

work schedule.

(d) "Pattern of violations" means a finding by the department

of 2 or more violations in 1 calendar year.

(e) "Registered professional nurse" or "R.N." means that term

as defined in section 17201.

(f) "Rural area" means an area that is located outside of a

metropolitan statistical area as defined by the Office of

Management and Budget under 42 USC 1395ww or that is located in a

city, village, or township with a population of no more than 12,000

and in a county with a population of no more than 110,000.

Population is determined according to the 2000 federal decennial

census.

(g) "Scrub assistant" means an individual functioning in a

role that is also known as a surgical technician, operating room

technician, surgical tech, first assistant, scrub tech, or scrub. A

scrub assistant may be a direct care registered professional nurse.

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

minimum specific number of direct care registered professional

nurses required to be working at all times in each unit for each

shift to ensure safe patient care.

(i) "Unforeseen emergent situation" means an occurrence that

is unpredictable, or unavoidable at an unscheduled or unpredictable

interval, and relates to health care delivery and requires

immediate medical intervention or care. Unforeseen emergent

situation does not include a state of emergency that results from a

labor dispute in the health care industry or consistent

understaffing.

Enacting section 1. This amendatory act takes effect 90 days

after the date it is enacted into law.