Bill Text: NJ A3683 | 2024-2025 | Regular Session | Introduced
Bill Title: Establishes "Patient Protection and Safe Staffing Act."
Spectrum: Partisan Bill (Democrat 9-0)
Status: (Introduced) 2024-02-12 - Introduced, Referred to Assembly Health Committee [A3683 Detail]
Download: New_Jersey-2024-A3683-Introduced.html
Sponsored by:
Assemblywoman ANNETTE QUIJANO
District 20 (Union)
SYNOPSIS
Establishes "Patient Protection and Safe Staffing Act."
CURRENT VERSION OF TEXT
As introduced.
An Act concerning staffing standards in certain health care facilities and supplementing Titles 26 and 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. This act shall be known and may be cited as the "Patient Protection and Safe Staffing Act."
2. The Legislature finds and declares that:
a. Because of recent changes in the health care delivery system, patients in general and special hospitals and ambulatory surgery facilities in the State, and in State developmental centers and psychiatric hospitals, generally have higher acuity levels than in the past;
b. Recent studies demonstrate the link between adequate registered professional nurse staffing and improved mortality rates and quality of care among patients in health care facilities;
c. Inadequate nurse staffing can result in dangerous medical errors, patient infections, and increased injuries to patients and caregivers;
d. Inadequate and poorly monitored nurse staffing practices jeopardize the delivery of health care services and adversely impact the health of patients;
e. The establishment of staffing standards for registered professional nurses in hospitals, ambulatory surgery facilities, and State developmental centers and psychiatric hospitals should not be construed as justifying understaffing with respect to other critical health care workers; safe staffing practices recognize the importance of all health care workers in providing quality patient care because the availability of these other health care workers enables registered professional nurses to focus on the nursing care functions that only these nurses, by law, are permitted to perform; and
f. Understaffing at hospitals, ambulatory surgery facilities, and State developmental centers and psychiatric hospitals has been demonstrated to be an underlying cause of the current nursing shortage, since higher patient assignments create higher levels of job dissatisfaction, burnout, and turnover rates among nurses.
3. As used in this act:
"Commissioner" means the Commissioner of Health.
"Department" means the Department of Health.
"Direct care registered professional nurse" means a registered professional nurse who is assigned to provide care for one or more patients in a specific unit, service, or department and is directly responsible for carrying out procedures, assessments, or other nursing protocols.
"Unlicensed assistive personnel" means any unlicensed or uncertified personnel employed by a licensed health care facility that perform nursing tasks which do not require the skill or judgment of a registered professional nurse and which are assigned to them by, and carried out under the supervision of, a registered professional nurse, in accordance with regulations promulgated by the Commissioner of Health pursuant to section 2 of P.L.1999, c.436 (C.26:2H-12.15).
4. a. In addition to staffing requirements provided by law or regulation on the effective date of this act, the Commissioner of Health shall adopt regulations that provide minimum direct care registered professional nurse-to-patient staffing ratios and unlicensed assistive personnel-to-patient staffing ratios for all patient units in general and special hospitals and ambulatory surgical facilities in accordance with the requirements of this act. The regulations shall not decrease any nurse-to-patient staffing ratios or unlicensed assistive personnel-to-patient staffing ratios in effect on the effective date of this act.
b. The regulations adopted pursuant to this section shall, at a minimum, provide for the following nurse-to-patient staffing ratios:
(1) one registered professional nurse for every four patients on a medical/surgical unit;
(2) one registered professional nurse for every three patients in a step down, telemetry, progressive care, or intermediate care unit;
(3) one registered professional nurse for every four patients in an emergency department, one registered professional nurse for every two patients in a critical care service of an emergency department, and one registered professional nurse for every patient in a trauma service of an emergency department;
(4) one registered professional nurse for every five patients in a behavioral health or psychiatric unit;
(5) one registered professional nurse for every two patients in a critical care, intensive care, neonatal, or burn unit;
(6) one registered professional nurse for every patient under anesthesia in an operating room, and one registered professional nurse for every one post-anesthesia patient in a recovery room or post-anesthesia care unit;
(7) one registered professional nurse for every three patients in a labor and delivery unit; one registered professional nurse for every four patients, including infants, in a postpartum unit in which the mother and infant share the same room; and one registered professional nurse for every six patients in a mothers-only unit; and
(8) one registered professional nurse for every four patients in a pediatric or intermediate care nursery unit, and one registered professional nurse for every six patients in a well-baby nursery.
c. The regulations adopted pursuant to this section shall, at a minimum, provide for the following unlicensed assistive personnel-to-patient staffing ratios:
(1) one unlicensed assistive personnel for every seven patients for the day shift of any patient unit; and
(2) one unlicensed assistive personnel for every 11 patients for the night shift of any patient unit.
5. a. The Commissioner of Health shall require all general and special hospitals and ambulatory surgical facilities to employ an acuity and staffing system, approved by the commissioner, for the purpose of increasing direct care registered professional nurse and unlicensed assistive personnel staffing levels above the minimum levels established in section 2 of this act, or otherwise provided by law or regulation, to ensure adequate staffing of each unit, service, or department, as applicable.
The acuity and staffing system shall meet the following requirements:
(1) be based on: patient classification or acuity; professional nurse staffing standards adopted by nurse specialty organizations; skill mix; and the staffing levels of other health care personnel and the use of agency or temporary staff;
(2) be established in the facility by the department of nursing with a majority of the unit staff nurses' approval, or with the approval of the collective bargaining agent for registered professional nurses at the facility;
(3) allow forecasting of staffing levels and provide a method to adjust staff for each patient care unit based on objective criteria, including, but not limited to:
(a) documented skills, training, and competency of staff to plan and provide nursing services in the nursing areas where they function;
(b) a patient database incorporating objective factors such as the case mix index, specific or aggregate patient diagnostic classifications or acuity levels, patient profiles, critical pathways or care progression plans, length of stay, and discharge plans;
(c) operational factors, such as unit size, design, and capacity, the admission/discharge/transfer index, and support service availability;
(d) contingency plans to address critical departures from the staffing plan, including policies and procedures to regulate closure of available beds if staffing levels fall below specified levels; and
(e) policies and procedures for the reassignment of staff, including float and agency staff; and
(4) permit waiver of minimum staffing level requirements in the event of an unforeseen emergent circumstance which causes significant changes in the patient census for a regular shift. Waiver shall not be permitted unless the facility has made reasonable efforts to provide sufficient additional staff to meet the required minimum staffing levels, including seeking volunteers and making use of on-call staff, per-diem staff, agency staff, and float pools. As used in this subsection, "unforeseeable emergent circumstance" means an unpredictable or unavoidable occurrence requiring immediate action.
b. A hospital or facility shall maintain a float pool of qualified registered professional nurses to accommodate changes in staffing needs.
c. A nurse who is assigned the duty of maintaining unit census for patients and staff or supervisory functions, or who spends a significant amount of time on non-nursing tasks, shall not be factored into the required staffing levels.
d. A registered professional nurse shall not be assigned to a unit, service, or department, or considered in the count of nursing staff in a unit, service, or department, unless that nurse has received prior orientation in the applicable clinical area and has demonstrated current competence in providing care in that unit, service, or department.
e. A hospital or facility shall not reduce the number of ancillary nursing personnel, which shall include, but not be limited to, nurse assistants, unit clerks, monitor technicians, and transport teams, on duty to meet the required staffing levels.
6. a. The Department of Health shall monitor and enforce the minimum staffing level requirements or the staffing and acuity system requirements established by this act through periodic inspection and in response to any complaint filed pursuant to subsection b. of this section.
b. A registered professional nurse or other staff member, a collective bargaining agent of a staff member, or a member of the public, who believes that the hospital or facility in which the nurse or staff member is employed is in violation of the staffing level requirements or the staffing and acuity system requirements established pursuant to this act, may file a complaint with the Commissioner of Health. The complaint shall be filed no later than 60 days after the date of the alleged violation, in a form and manner determined by the commissioner.
c. No later than 14 days after the filing of a complaint pursuant to subsection b. of this section, the department shall send a copy of the complaint to the collective bargaining agent of the staff member, who filed a complaint, if applicable.
d. (1) Within 30 days of the filing of a complaint pursuant to subsection b. of this section, the commissioner shall:
(a) commence an investigation of the complaint to determine whether or not a hospital or facility is in violation of the provisions of this act; and
(b) provide a notice of the investigation to the hospital or facility and any collective bargaining agent of any staff member employed at the hospital or facility, if applicable.
(2) In conducting the investigation, the department may conduct on-site inspections of the patient unit identified in the complaint, conduct interviews, compel the production of documents and records pertaining to the complaint, and take any other action as may be necessary to ensure compliance with the provisions of this act.
(3) The department shall conclude any investigation conducted pursuant to this subsection no later than 60 days after the commencement of such investigation.
(4) Following the completion of an investigation conducted pursuant to this subsection, in which investigation the department determines a hospital or facility to be in violation of the staffing level requirements or the staffing and acuity system requirements established pursuant to this act, the hospital or facility shall be issued a warning for a first offense and liable to a civil penalty of no more than $1,750 for a second offense occurring within a four-year period, no more than $2,5000 for a third offense occurring within a four-year period, and no more than $5,000 for a fourth offense or subsequent offense occurring within a four-year period. For the purposes of this paragraph, each violation shall constitute a separate offense. The civil penalty shall be collected in a summary proceeding, brought in the name of the State in a court of competent jurisdiction pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.). Any money collected by the court in payment of a civil penalty imposed pursuant to this paragraph shall be conveyed to the State Treasurer for deposit into the Patient Protection and Staffing Fund, established pursuant to section 7 of this act. Nothing in this act shall be construed to limit the ability to bring any civil, criminal, or administrative action for conduct constituting a violation of any other provision of law.
(5) The department shall prepare and provide to the complainant and the complainant's collective bargaining agent, if applicable, a written report of the department's findings from the investigation, which report shall include a summary of the complaint, the department's findings and the factual basis of those findings, any penalties imposed on the hospital or facility, and any other information the department determines to be necessary to include in the report. The report shall not include any personally identifiable information.
The department shall post on its Internet website any report prepared pursuant to this paragraph for any investigation, in which investigation the department found a violation of the staffing levels requirements or the staffing and acuity system requirements established pursuant to this act.
7. a. There is created in the Department of the Treasury a dedicated, non-lapsing fund to be known as the "Patient Protection and Staffing Fund."
b. The fund shall be credited with monies collected by the court in payment of any civil penalty imposed pursuant to paragraph (4) of subsection d. of section 6 of this act.
c. The State Treasurer shall be the custodian of the fund and all disbursements from the fund shall be made by the State Treasurer upon vouchers signed by the Commissioner of Health. The monies in the fund shall be invested and reinvested by the Director of the Division of Investment in the Department of the Treasury as are other trust funds in the custody of the State Treasurer in the manner provided by law. Interest received on the monies in the fund shall be credited to the fund.
d. Moneys in the fund shall be dedicated and used only for the purposes of: increasing the number of inspectors employed by the Department of Health to enforce the provisions of this act; advancing nursing recruitment and retentions programs; supporting student loan forgiveness for nursing students; and increasing pay for nursing teaching staff.
8. The Commissioner of Health shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt regulations, within 90 days of the effective date of this act, as necessary to carry out the provisions of this act.
The commissioner shall hold a public hearing on the proposed regulations within 30 days of their publication in the New Jersey Register.
9. The Commissioner of Human Services shall conduct a review of Department of Human Services regulations concerning registered professional nurse staffing standards in developmental centers and State psychiatric hospitals, and shall revise the regulations, as appropriate, to reflect safe staffing practices and assure adequate staffing at the facilities.
10. This act shall take effect on the first day of the 12th month after enactment, but the Commissioners of Health and Human Services may take such anticipatory administrative action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill establishes the "Patient Protection and Safe Staffing Act," which provides certain staffing standards in State hospitals, ambulatory surgical facilities, developmental centers, and psychiatric hospitals.
Specifically, the bill provides that, in addition to existing staffing requirements provided by law or regulation, the Commissioner of Health is to adopt regulations that provide minimum direct care registered professional nurse-to-patient staffing ratios and unlicensed assistive personnel-to-patient staffing ratios for all patient units in general and special hospitals and ambulatory surgical facilities, in accordance with the minimum staffing requirements that are established by the bill. The regulations adopted by the Commissioner of Health are not to decrease any staffing ratios that are already in effect on the bill's effective date.
The bill provides that the Commissioner of Health is to require all general and special hospitals and ambulatory surgical facilities to employ an acuity and staffing system for the purpose of increasing staffing levels above the minimum levels established in the bill, or otherwise provided by law or regulation, in order to ensure adequate staffing of each unit, service, or department.
The bill requires the Department of Health to enforce the bill's requirements by conducting periodic inspections and responding to complaints. A registered professional nurse or other staff member, a collective bargaining agent of a staff member, or a member of the public, who believes that the hospital or facility in which the nurse or staff member is employed is in violation of the requirements established by the bill, may file a complaint with the Commissioner of Health. In responding to a complaint, the commissioner will be required to conduct an investigation to determine whether or not a hospital or facility is in violation.
Following the completion of an investigation, in which investigation the department determines a hospital or facility to be in violation of the requirements established by the bill, the hospital or facility may be issued a civil penalty in increasing amounts for repeat violations. Any money collected by the court in payment of a civil penalty imposed will be conveyed to the State Treasurer for deposit into the Patient Protection and Staffing Fund (fund) established by the bill.
Moneys in the fund will be dedicated and used only for the purposes of increasing the number of inspectors employed by the Department of Health to enforce the provisions of the bill, advancing nursing recruitment and retentions programs, supporting student loan forgiveness for nursing students, and increasing pay for nursing teaching staff.
Finally, in addition to the above-described requirements applicable to the Commissioner of Health, the bill requires the Commissioner of Human Services to conduct a review of Department of Human Services regulations concerning registered professional nurse staffing standards in developmental centers and State psychiatric hospitals, and to revise the regulations, as appropriate, to reflect safe staffing practices and assure adequate staffing at the facilities.
