Bill Text: HI HB807 | 2021 | Regular Session | Introduced
Bill Title: Relating To Nurses.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2021-01-27 - Referred to LAT/HHH, CPC, referral sheet 1 [HB807 Detail]
Download: Hawaii-2021-HB807-Introduced.html
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
807 |
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THIRTY-FIRST LEGISLATURE, 2021 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to NUrses.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that health care services are becoming complex and it is increasingly difficult for patients to access integrated services. Quality of patient care is jeopardized because of staffing changes implemented in response to managed care.
The legislature further finds that, to ensure the adequate protection of patients in acute care settings, it is essential that qualified registered nurses be accessible and available to meet the needs of patients. The basic principles of staffing in the acute care setting should be based on the patient's care needs, the severity of condition, services needed, and the complexity surrounding those services.
The purpose of this Act is to:
(1) Prohibit a hospital
from assigning unlicensed assistive
personnel to perform nursing care tasks, functions, and activities that would
otherwise fall under the scope of practice of a registered nurse or permitting a
registered nurse to delegate certain tasks, functions, and activities to unlicensed
assistive personnel;
(2) Prohibit registered nurses from being assigned to a nursing unit or critical
care area unless registered nurses receive orientation and demonstrate individual
competency;
(3) Require the department of health to adopt rules that establish requirements
related to registered nurse-to-patient ratios in licensed hospitals; and
(4) Require the department of health to submit a report to the legislature.
SECTION 2. Chapter 321, part I, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§321- Registered
nurses; delegation; staffing levels. (a) A hospital licensed
pursuant to this chapter shall not assign unlicensed assistive personnel to
perform nursing care tasks, functions, and activities that would otherwise fall
under the scope of practice of a registered nurse licensed under chapter
457. A hospital shall not permit a
registered nurse to delegate nursing care tasks, functions, and activities to
unlicensed assistive personnel that require a substantial amount of scientific
knowledge and technical skills, including:
(1) Administration of
medication;
(2) Venipuncture of
intravenous therapy;
(3) Parenteral or tube
feedings;
(4) Invasive procedures,
including inserting nasogastric tubes, inserting catheters, or tracheal suctioning;
(5) Assessment of patient
condition;
(6) Educating patients
and their families concerning the patients' health care problems, including post-discharge
care; and
(7) Moderate complexity
laboratory tests;
provided that
nothing in this section shall be construed to restrict the practice of another health
care provider licensed in the State from practicing within that health care provider's
own recognized scope of practice.
(b) No
registered nurse shall be assigned to a nursing unit or clinical area unless that
nurse has first received orientation in that unit or area sufficient to demonstrate
individual competency and ability to provide appropriate care to patients in that
unit or area.
(c) No
later than , the department
shall adopt rules pursuant to chapter 91 that establish minimum, specific, and numerical
registered nurse-to-patient ratios by hospital unit for all hospitals licensed under
this chapter. The rules shall include requirements
that:
(1) Establish the minimum
number of registered nurses that shall be allocated within each hospital unit;
(2) Establish additional
staffing requirements assigned in accordance with a documented patient classification
system for determining nursing care requirements, including:
(A) Severity
of a patient's illness;
(B) Need
for specialized equipment and technology;
(C) Complexity
of clinical judgment needed to design, implement, and evaluate a patient care plan
and the ability for self-care; and
(D) Licensure
requirements for health care providers offering care pursuant to the requirements
under this paragraph.
(3) Provide flexibility
for rural health centers, included requests for a waiver from the requirements of
this section; provided that any waiver shall not jeopardize the health, safety,
and well-being of patients at the rural health center;
(4) Distinguish between
regularly scheduled registered nurse core staff in an emergency medical services
department and additional registered nurses providing critical care services to
patients in an emergency medical services department;
(5) Consider the unique
needs of psychiatric patients receiving care at a licensed hospital; and
(6) Consider the unique
nurse-to-patient ratios for participants in a board-recognized nurse residency program;
provided that the department shall coordinate with the board of nursing to establish
requirements pursuant to this paragraph.
(d) Rules adopted pursuant
to this subsection shall not supersede any existing registered nurse-to-patient
ratio requirements that may be in place for:
(1) The Hawaii state
hospital or any facility operated by the Hawaii health systems corporation; or
(2) Intensive care units,
neonatal intensive care units, or operating rooms within a licensed hospital.
(e) All
hospitals shall adopt written policies and procedures for training and mandatory
orientation of nursing staff.
(f) Except
as provided by subsection (a), in the event of a conflict between this section and
any provision of chapter 457 or rules adopted by the board of nursing pursuant to
this section, chapter 457 and any rules adopted pursuant to that chapter shall prevail.
(g) The
department shall submit a report to the legislature no later than twenty days
prior to the convening of the regular session of 2026, on its efforts to comply
with this section, including any proposed changes to the rules adopted pursuant
to this section.
(h) For
purposes of this section:
"Critical care unit" means a unit that
is established to safeguard and protect patients whose severity of medical conditions
requires continuous monitoring and complex intervention by registered nurses.
"Hospital unit" means a critical care
unit, burn unit, labor and delivery room, post-anesthesia service area, emergency
medical services department, operating room, pediatric unit, stepdown or intermediate
care unit, specialty care unit, telemetry unit, general medical care unit, subacute
care unit, and transitional inpatient care unit."
SECTION 3. Section 457-7.5, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:
"(a) [A] Except as provided in section 321- (a),
a registered nurse may delegate nursing care tasks, functions, and
activities to unlicensed assistive personnel in a manner that is appropriate to
the level of knowledge and skill of the unlicensed assistive personnel; provided
that the delegation of tasks, functions, and activities complies with
applicable federal and state laws; and provided further that the
practice-pervasive functions of assessment, evaluation, and nursing judgment
shall not be delegated."
SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 5. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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Report Title:
Nurses; Registered Nurses; Hospitals; Registered Nurse to Patient Ratios; Rules; Department of Health
Description:
Prohibits a hospital from assigning unlicensed assistive personnel to perform nursing care tasks, functions, and activities that would otherwise fall under the scope of practice of a registered nurse or permitting a registered nurse to delegate certain tasks, functions, and activities to unlicensed assistive personnel. Prohibits registered nurses from being assigned to a nursing unit or critical care area unless registered nurses receive orientation and demonstrate individual competency. Requires the department of health to adopt rules that establish requirements related to registered nurse-to-patient ratios in licensed hospitals. Requires a report to the legislature.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.
