First Regular Session Sixty-sixth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 07-0083.01 Christy Chase SENATE BILL 07-010 SENATE SPONSORSHIP Tochtrop, HOUSE SPONSORSHIP Frangas, Senate Committees House Committees Health and Human Services A BILL FOR AN ACT Concerning nurse staffing levels in hospitals. Bill Summary (Note: This summary applies to this bill as introduced and does not necessarily reflect any amendments that may be subsequently adopted.) Health Care Task Force. Requires each hospital to develop, implement, file with the department of public health and environment (department), and make available to patients upon request a staffing plan for the hospital that sets forth the minimum number of registered nurses, licensed practical nurses, and other personnel providing direct patient care required in each patient care unit in the hospital. Specifies the criteria to be used in developing a staffing plan, and requires input from a staffing committee consisting of a minimum percentage of the registered nurses providing direct patient care in the hospital. Mandates the inclusion of hospital staffing plans and certain nurse staffing information on the hospital report card developed by the department. Obligates hospitals to staff each patient care unit in accordance with their staffing plans, and allows a modification to the staffing plan for a particular patient care unit in an emergency. Compels hospitals to maintain accurate daily records and to submit nurse staffing information to the department at least semiannually. Prohibits a hospital from retaliating against or intimidating an employee for participating on the staffing committee or notifying the staffing committee, the hospital's administration, or the department of a deviation from a staffing plan or failure to develop or implement a staffing plan. Requires the department to investigate complaints of violations. Allows the department to impose civil penalties or suspend or revoke a hospital's license or certificate of compliance for violations. Specifies that the department is to submit a report to the health and human services committees of the senate and house of representatives regarding hospital compliance with the requirements of this act. Allows the state board of health to adopt rules to implement this act. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Part 1 of article 3 of title 25, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SECTION to read: 25-3-110. Hospital staffing plans - nurse services - state board rules - nurse-to-patient ratios - definitions. (1) As used in this section, unless the context otherwise requires: (a) "Department" means the department of public health and environment created in section 25-1-102. (b) "Executive director" means the executive director of the department. (c) "Intensity" means the level of patient needs as determined by a registered nurse providing direct patient care, taking into account at least the following factors: (I) The severity and urgency of the patient's admitting condition; (II) Scheduled procedures; (III) The patient's ability to meet health care requisites; (IV) The patient's availability of social supports; (V) Age and functional ability of the patient; (VI) Communication skills of the patient; and (VII) Other needs identified by the patient and the registered nurse. (d) "Patient care unit" means any unit of a hospital that provides patient care. (e) "Skill mix" means the number of registered nurses, licensed practical nurses, and other personnel providing direct patient care. (f) "State board" means the state board of health created in section 25-1-103. (2) Each hospital in the state shall appoint a staffing committee to assist in the development and implementation of a staffing plan for the hospital. At least one-half of the members of the staffing committee shall be registered nurses currently providing direct patient care in the hospital. If the registered nurses employed by the hospital have elected a collective bargaining representative, the registered nurse representatives on the staffing committee shall be selected by the collective bargaining representative. Participation in the staffing committee shall be considered part of the employee's regularly scheduled work week. (3) (a) By August 15, 2007, each hospital in the state shall develop and implement a staffing plan for nursing services. The hospital shall collaborate with its staffing committee in the development and implementation of the staffing plan. The hospital shall file the staffing plan with the department, shall post the staffing plan for each patient care unit in the appropriate patient care unit in the hospital, and shall provide a copy of the applicable staffing plan to a current or prospective patient of a patient care unit upon request. The hospital, in collaboration with its staffing committee, shall review and update its staffing plan annually and file any updated staffing plan with the department. The department shall include each hospital's current staffing plan on the hospital report card developed and made available pursuant to section 25-3-703. (b) A hospital staffing plan shall: (I) Set the minimum skill mix required in each patient care unit in the hospital based on the following criteria in each patient care unit: (A) Patient census information, including patient discharges, admissions, and transfers; (B) Level of intensity of all patients and the nature of the care to be delivered on each shift; (C) The skill level, experience, and specialty certification or training of those providing care in the unit; and (D) The need for specialized or intensive equipment; (II) Include appropriate limits on the use of agency and traveling nurses; (III) Be consistent with the scopes of practice of registered nurses and licensed practical nurses and the authorized duties of other personnel providing direct patient care; (IV) Include adequate administrative staff in each patient care unit to ensure that nurses providing direct patient care are not hindered in the delivery of that care; (V) Include a process for an annual internal review by the staffing committee that ensures compliance with the staffing plan, provides for review of incidents and staff concerns, and tracks staffing patterns and the number of patients and their acuity; and (VI) Comply with and not diminish existing standards in any applicable collective bargaining agreement. (4) (a) A hospital shall staff each patient care unit in accordance with its staffing plan. The hospital may deviate from a staffing plan in cases of emergency, as determined by the hospital. The hospital shall make a record of any deviation from a staffing plan and report the deviation to the department in a manner determined by the department. (b) A hospital shall maintain and post a list of qualified, on-call nursing staff and nursing services that may be called to provide replacement staff in the event of sickness, vacations, vacancies, and other absences of nursing staff. The list shall provide a sufficient number of replacement staff for the hospital on a regular basis. (5) (a) Hospitals shall maintain accurate daily records showing: (I) The number of patients present in each patient care unit at the end of each standard shift within the hospital; (II) The number of admissions, discharges, transfers, and observation patients in each patient care unit and during each shift; and (III) The skill mix in each patient care unit during each shift. (b) The daily records shall be retained for at least seven years and shall be made available upon request to the department and the staffing committee. (6) At least twice a year, hospitals shall collect and submit to the department the following nurse staffing information: (a) The mix of registered nurses, licensed practical nurses, and other personnel caring for patients as a percentage of the total of all nursing care hours in each patient care unit; (b) The total nursing care hours provided per patient day in each patient care unit; (c) The average number of pressure ulcers per patient; and (d) The average number of patient falls per one thousand patient days. (7) (a) A hospital shall not retaliate against or intimidate an employee for performing any duties or responsibilities in connection with participation on the staffing committee. (b) A hospital shall not retaliate against or intimidate an employee who notifies the staffing committee, the hospital's administration, or the department that a staffing schedule for a patient care unit fails to comply with the posted staffing plan or that the hospital has failed to develop or implement a staffing plan as required by this section. (8) (a) The department shall investigate complaints of violations of this section and may impose civil penalties, not to exceed five thousand dollars per day per violation, or suspend or revoke a hospital's license or certificate of compliance for violation of this section. Each violation of a staffing plan shall be considered a separate violation. (b) The department shall maintain and make available to the public records of any civil penalties, administrative actions, or license or certificate suspensions or revocations imposed on hospitals for a violation of this section. (c) The department shall submit an annual report to the health and human services committees of the senate and house of representatives, or their successor committees, regarding hospital staffing plans, including information pertaining to hospital compliance with the requirements of this section. The department shall make the report available to the public. (9) The state board shall adopt rules as necessary to implement this section. SECTION 2. 25-3-703, Colorado Revised Statutes, is amended to read: 25-3-703. Hospital report card - staffing plans. (1) The executive director shall approve a Colorado hospital report card consisting of public disclosure of data assembled pursuant to this part 7, the hospital staffing plans required by section 25-3-110 (3), and the nurse staffing information required by section 25-3-110 (6). At a minimum, the data, hospital staffing plans, and nurse staffing information shall be made available on an internet website in a manner that allows consumers to conduct an interactive search that allows them to view and compare the information for specific hospitals. The website shall include such additional information as is determined necessary to ensure that the website enhances informed decision making among consumers and health care purchasers, which shall include, at a minimum, appropriate guidance on how to use the data, hospital staffing plans, and nurse staffing information and an explanation of why the data, hospital staffing plans, or nurse staffing information may vary from hospital to hospital. The data All information specified in this subsection (1) shall be released on or before November 30, 2007. (2) Prior to the completion of the Colorado hospital report card, the executive director shall ensure that every hospital is allowed thirty days within which to examine the data, hospital staffing plans, and nurse staffing information and submit comments for consideration and inclusion in the final Colorado hospital report card. SECTION 3. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety.