February 3, 2005, Introduced by Senators PATTERSON, PRUSI, BASHAM, JACOBS, OLSHOVE, SCHAUER, BRATER, CHERRY and BARCIA 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 the
amendatory act that added this section and annually thereafter, a
hospital shall submit to the department a staffing plan as provided
under this section. Each hospital is responsible for the
development and implementation of 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. Each 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, the
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 shall be 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 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 under subsection
(4).
(3) Within 2 years after the effective date of the amendatory
act that added this section, each hospital shall have established
and implemented 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 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 the amendatory
act that added 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 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 under this subsection, in
computing the registered professional nurse-to-patient ratio
required under subsection (4), the 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 emergency
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) The 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) If a hospital fails 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, as adjusted in
accordance with the hospital's acuity system or assessment tool to
maintain safe patient care, the hospital is in violation of this
section. Each violation shall be reported to the department by the
hospital's designated representative, 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.