BillTracker

Concerning nursing staffing practices at hospitals (Cody, Doglio, Ryu)

Establishes the Washington state patient safety act. Requires the department of health to: (1) With stakeholder input, adopt patient assignment limits and recommend quality indicators; (2) Upon receipt of a complaint, conduct an audit of a hospital's compliance with this act and investigate complaints of violations of this act; and (3) Maintain, for public inspection, records of civil penalties, administrative actions, or license suspensions or revocations imposed on hospitals. Requires a hospital to: (1) Submit a staffing plan to the department of health, implement the staffing plan, and assign nursing personnel to each patient care unit in accordance with the plan; and (2) Regularly collect information regarding nurse staffing and submit it to the department of health.

1ST SUBSTITUTE COMPARED TO ORIGINAL:
-removes the requirement that the Department of Health (DOH) adopt patient assignment limits;
-removes the prohibition against assigning a registered nurse (RN) to a nursing unit unless the RN has received an orientation and demonstrated competency;
-requires a hospital to adopt an alternate staffing plan if it does not adopt the nurse staffing committee's plan, instead of requiring the hospital to adopt the committee's
plan;
-changes the penalties for violating provisions relating to nurse staffing plans to $100 per day, instead of between $2,500 and $10,000 per violation;
-removes the expansion of nonretaliation provisions relating to nurse staffing plans;
-removes the prohibition against penalizing a nurse for refusing to accept certain assignments; and
-removes the requirement that hospitals report nurse staffing and patient care data to the DOH

EFFECT OF HOUSE FLOOR STRIKER AMENDMENT:
(1) Expands the factors that must be considered in the development of a nurse staffing plan to include strategies to enable nurses to take meal and rest breaks as required by law or an applicable collective bargaining agreement. Requires nurse staffing committees to review, assess, and respond to staffing variations. Requires (instead of allows) the nurse staffing committee to take hospital finances into account when developing the nurse staffing plan. (2) Requires a hospital that does not adopt the nurse staffing committee's plan to identify elements of the proposed plan being changed or prepare an alternate plan. Changes the date upon which a hospital must adopt the plan and submit it to the Department ofHealth (DOH) to January 1, 2019 (instead of June 30, 2019). Requires updates to the plan to be submitted to the DOH. (3) Allows a nurse to report to the nurse staffing committee any variations where the nurse personnel assignment in a patient care unit is not in accordance with the staffing plan and to make a complaint to the committee based on the variations. Allows shift-toshift adjustments in staffing levels only by appropriate hospital personnel overseeing patient care operations and only after consultation with impacted nurses. Allows an affected nurse to submit a complaint to the nurse staffing committee regarding shift-to-shift adjustments. Requires nurse staffing committees to develop a process to examine and respond to data regarding certain complaints, including the ability to determine if a specific complaint is resolved or dismissing a complaint based on unsubstantiated data. (4) Limits the DOH's ability to impose $100 per day fines regarding nurse staffing plans to certain circumstances, including failure to: (a) Form or establish a staffing committee, (b) conduct a semiannual review of a nurse staffing plan, (c) submit a nurse staffing plan or update to the DOH, or (d) follow the nursing personnel assignments as adopted by the hospital as evidenced by the aggregate data on concerns for either shift-to-shift adjustments or reports of variations not in accordance with the adopted plan--this must be evidenced by a minimum of a 60-day period of aggregate unresolved complaint data (does not apply in cases of unforeseen emergency circumstances or where the hospital, after consultation with the staffing committee, documents it has made reasonable efforts to obtain staffing to meet required assignments but has been unable to do so). Defines "unforeseen emergency circumstance" as any unforeseen declared national, state, or municipal emergency, when a health care facility disaster plan is activated, any unforeseen disaster or other catastrophic event that substantially affects or increases the need for health care services, or when hospitals in a community are diverting patients to other hospitals for treatment. Requires a hospital's plan of corrective action to be submitted within 45 days of the presentation of findings by the DOH. Clarifies that the $100 per day fine applies for all violations asserted against a hospital at any time and ends when the hospital submits or begins to follow a corrective plan of action or other action agreed to by the DOH. (5) Removes the DOH's rule-making authority. Makes changes to the findings section.

EFFECT OF SENATE WAYS & MEANS COMMITTEE STRIKER AMENDMENT:
(1) Removes the requirement that hospital personnel overseeing patient care operations consult with registered nurses before making shift-to-shift adjustments in staffing levels.
(2) Prohibits the Department of Health (DOH) from investigating a complaint in the event of unforeseeable emergency circumstances, or if a hospital has made reasonable efforts to obtain staffing to meet required assignments.
(3) Allows DOH to investigate complaints relating to staffing assignments or shift-to-shift adjustments in staffing levels only if the data contained in the complaints indicate a continuing pattern of unresolved violations of these policies.

EFFECT OF SENATE STRIKER AMENDMENT:
(1) Provides that the Department of Health (DOH) may only investigate a complaint relating to nursing personnel assignments in a patient care unit or shift-to-shift adjustments in staffing levels after DOH makes an assessment that the evidence shows a continuing pattern of unresolved violations, excluding resolved complaints. The evidence must indicate a continuing pattern of unresolved violations for a continuous sixty-day period before the complaint is received by DOH.
(2) Requires DOH to submit a report, after stakeholder review, to the legislature on the number of complaints submitted to DOH, how they were disposed, the number of investigations conducted, and the costs of complaint investigations. This report must also include any impact on hospital licensing fees.
(3) Prohibits fees to be increased to implement the act before June 1, 2023.


EFFECT OF SENATE STRIKER (2) AFTER HOUSE REJECTED 1ST STRIKER:
Requires the Department report to be provided to the legislature on December 31, 2020, instead of December 31, 2022. The requirement that fees not be increased to implement the act is limited to July 1, 2021, rather than June 1, 2023.

Hearing Date: Friday, March 31, 2017 -- 1:00 pm

WA State Legislature Link:
http://app.leg.wa.gov/billsummary?BillNumber=1714&Year=2017    (opens a new browser tab)