Bill Text: MN HF588 | 2013-2014 | 88th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Hospital staffing report required, study on nurse staffing levels and patient outcomes required, funding provided, and money appropriated.
Spectrum: Moderate Partisan Bill (Democrat 6-1)
Status: (Passed) 2013-05-14 - Secretary of State Chapter 51 05/09/13 [HF588 Detail]
Download: Minnesota-2013-HF588-Introduced.html
Bill Title: Hospital staffing report required, study on nurse staffing levels and patient outcomes required, funding provided, and money appropriated.
Spectrum: Moderate Partisan Bill (Democrat 6-1)
Status: (Passed) 2013-05-14 - Secretary of State Chapter 51 05/09/13 [HF588 Detail]
Download: Minnesota-2013-HF588-Introduced.html
1.2relating to health; requiring hospitals to provide staffing at levels consistent with
1.3nationally accepted standards; requiring reporting of staffing levels;proposing
1.4coding for new law in Minnesota Statutes, chapter 144.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [144.591] STANDARDS OF CARE ACT.
1.7 Subdivision 1. Title. This section may be cited as the "Standards of Care Act."
1.8 Subd. 2. Definitions. For purposes of this section, the following terms have the
1.9meanings given:
1.10(a) "Assignment" means the provision of care to a patient for whom a direct care
1.11registered nurse has responsibility within the nurse's scope of practice.
1.12(b) "Direct care registered nurse" means a registered nurse, as defined in section
1.13148.171, who is directly providing nursing care to patients.
1.14(c) "Nursing intensity" means a patient-specific, not diagnosis-specific, measurement
1.15of nursing care resources expended during a patient's hospitalization. A measurement of
1.16nursing intensity includes the complexity of care required for a patient and the knowledge
1.17and skill needed by a nurse for surveillance of patients in order to make continuous,
1.18appropriate clinical decisions in the care of patients.
1.19(d) "Patient acuity" means the measure of a patient's severity of illness or medical
1.20condition including, but not limited to, the stability of physiological and psychological
1.21parameters and the dependency needs of the patient and the patient's family. Higher
1.22patient acuity requires more intensive nursing time and advanced nursing skills for
1.23continuous surveillance.
2.1(e) "Skill mix" means the composition of nursing staff by licensure and education
2.2including, but not limited to, registered nurses, licensed practical nurses, and unlicensed
2.3personnel.
2.4(f) "Surveillance" means the continuous process of observing patients for early
2.5detection and intervention in an effort to prevent negative patient outcomes.
2.6(g) "Unit" means an area or location of a hospital where patients receive care based
2.7on similar patient acuity and nursing intensity.
2.8 Subd. 3. Staffing. (a) As a condition of licensure, hospitals must, at all times,
2.9provide enough qualified registered nursing personnel on duty to provide the standard of
2.10care that is necessary for the well-being of the patients, consistent with nationally accepted
2.11evidence-based standards established by professional nursing specialty organizations,
2.12including, but not limited to, the following:
2.13(1) Association of Women's Health, Obstetric and Neonatal Nurses;
2.14(2) Association of Operating Room Nurses;
2.15(3) Emergency Nurses Association; and
2.16(4) American Association of Critical Care Nurses.
2.17(b) In the absence of an evidence-based standard established for a specific
2.18hospital care unit as provided in paragraph (a), a working group must be created by the
2.19commissioner to review evidence-based research and develop a standard. The working
2.20group must be staffed by the commissioner or the commissioner's designee and must
2.21include, but is not limited to, the following members appointed by the governor:
2.22(1) one member who represents the Minnesota Hospital Association;
2.23(2) one member who represents the Minnesota Nurses Association;
2.24(3) two members of the public;
2.25(4) two members who are registered nurses and represent greater Minnesota;
2.26(5) two members who are registered nurses and represent the metropolitan area;
2.27(6) two members who are registered nurses and represent hospitals licensed for
2.2825 beds or less; and
2.29(7) two members who are registered nurses and represent hospitals licensed for
2.30more than 25 beds.
2.31Costs incurred for staffing and managing this working group shall be paid for with hospital
2.32licensing fees.
2.33 Subd. 4. Assignment adjustments. (a) Hospitals must assign nursing personnel
2.34to each patient care unit consistent with nationally accepted nursing clinical standards.
2.35If a direct care registered nurse determines, based on the nurse's professional judgment,
2.36that adjustments in staffing levels are required due to patient acuity and nursing intensity,
3.1then shift-to-shift adjustments in staffing levels must be made according to procedures
3.2developed by the Safe Patient Assignment Committee, established pursuant to subdivision
3.35. Hospitals must not use mandatory overtime as a means to meet staffing standards.
3.4(b) A direct care registered nurse may not be disciplined for refusing to accept an
3.5assignment if, in good faith and in the nurse's professional judgment, the nurse determines
3.6that the assignment is unsafe for patients due to patient acuity and nursing intensity.
3.7 Subd. 5. Safe Patient Assignment Committee. (a) By July 1, 2014, every hospital
3.8licensed in the state must establish a Safe Patient Assignment Committee either by
3.9creating a new committee or assigning the functions of a staffing for patient safety
3.10committee to an existing committee.
3.11(b) Membership of the committee must include, but is not limited to, the following
3.12members:
3.13(1) at least 60 percent of the membership must be registered nurses who provide
3.14direct patient care; and
3.15(2) collective bargaining-appointed members to proportionately represent its nurses.
3.16Hospitals must compensate registered nurses who are employed by the hospital and serve on
3.17the staffing for Safe Patient Assignment Committee for time spent on committee business.
3.18(c) Safe Patient Assignment Committees shall:
3.19(1) complete a staffing for patient safety assessment by March 31, 2014, and
3.20annually thereafter that identifies the following:
3.21(i) problems of insufficient staffing including, but not limited to, inappropriate
3.22number of registered nurses scheduled in a unit, inappropriately experienced registered
3.23nurses scheduled for a particular unit, inability for nurse supervisors to adjust for increased
3.24acuity or activity in a unit, and chronically unfilled positions within the hospital;
3.25(ii) units that pose the highest risk to patient safety due to inadequate staffing; and
3.26(iii) solutions for problems identified under items (i) and (ii);
3.27(2) implement and evaluate staffing standards provided in subdivision 3;
3.28(3) convert national standards described in subdivision 3 into registered nurse hours
3.29of care per patient;
3.30(4) recommend a mechanism for tracking and analyzing staffing trends within the
3.31hospital;
3.32(5) develop a procedure for making shift-to-shift adjustments in staffing levels when
3.33such adjustments are required by patient acuity and nursing intensity; and
3.34(6) identify any incidents when the hospital has failed to meet the standards provided
3.35in subdivision 3 and recommend a remedy.
4.1 Subd. 6. Posting staffing levels. (a) Staffing levels for each unit must be
4.2conspicuously posted in each unit and in waiting areas. The postings must be visible
4.3to hospital staff, patients, and the public.
4.4(b) The commissioner must post on the Department of Health's Web site the
4.5standards for each unit as defined under subdivision 3.
4.6 Subd. 7. Reporting. Hospitals must publicly report hours-per-patient direct care
4.7that registered nurses spend per patient on all patient care units. The first report is due
4.8March 31, 2014, and quarterly thereafter. The report must include actual hours worked by
4.9registered nurses per patient, not scheduled hours. This report must be submitted to the
4.10commissioner and posted on the hospital's Web site and on the Department of Health's
4.11Web site. This report must be titled the "Real Time RN Staffing Report." Beginning
4.12March 31, 2015, hospitals must publicly report patient outcomes relative to actual hours
4.13worked by registered nurses per patient.
4.14 Subd. 8. Enforcement. The commissioner may sanction a hospital for failure to
4.15comply with the provisions of this section, including failure to staff patient care units
4.16at required levels.
1.3nationally accepted standards; requiring reporting of staffing levels;proposing
1.4coding for new law in Minnesota Statutes, chapter 144.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. [144.591] STANDARDS OF CARE ACT.
1.7 Subdivision 1. Title. This section may be cited as the "Standards of Care Act."
1.8 Subd. 2. Definitions. For purposes of this section, the following terms have the
1.9meanings given:
1.10(a) "Assignment" means the provision of care to a patient for whom a direct care
1.11registered nurse has responsibility within the nurse's scope of practice.
1.12(b) "Direct care registered nurse" means a registered nurse, as defined in section
1.13148.171, who is directly providing nursing care to patients.
1.14(c) "Nursing intensity" means a patient-specific, not diagnosis-specific, measurement
1.15of nursing care resources expended during a patient's hospitalization. A measurement of
1.16nursing intensity includes the complexity of care required for a patient and the knowledge
1.17and skill needed by a nurse for surveillance of patients in order to make continuous,
1.18appropriate clinical decisions in the care of patients.
1.19(d) "Patient acuity" means the measure of a patient's severity of illness or medical
1.20condition including, but not limited to, the stability of physiological and psychological
1.21parameters and the dependency needs of the patient and the patient's family. Higher
1.22patient acuity requires more intensive nursing time and advanced nursing skills for
1.23continuous surveillance.
2.1(e) "Skill mix" means the composition of nursing staff by licensure and education
2.2including, but not limited to, registered nurses, licensed practical nurses, and unlicensed
2.3personnel.
2.4(f) "Surveillance" means the continuous process of observing patients for early
2.5detection and intervention in an effort to prevent negative patient outcomes.
2.6(g) "Unit" means an area or location of a hospital where patients receive care based
2.7on similar patient acuity and nursing intensity.
2.8 Subd. 3. Staffing. (a) As a condition of licensure, hospitals must, at all times,
2.9provide enough qualified registered nursing personnel on duty to provide the standard of
2.10care that is necessary for the well-being of the patients, consistent with nationally accepted
2.11evidence-based standards established by professional nursing specialty organizations,
2.12including, but not limited to, the following:
2.13(1) Association of Women's Health, Obstetric and Neonatal Nurses;
2.14(2) Association of Operating Room Nurses;
2.15(3) Emergency Nurses Association; and
2.16(4) American Association of Critical Care Nurses.
2.17(b) In the absence of an evidence-based standard established for a specific
2.18hospital care unit as provided in paragraph (a), a working group must be created by the
2.19commissioner to review evidence-based research and develop a standard. The working
2.20group must be staffed by the commissioner or the commissioner's designee and must
2.21include, but is not limited to, the following members appointed by the governor:
2.22(1) one member who represents the Minnesota Hospital Association;
2.23(2) one member who represents the Minnesota Nurses Association;
2.24(3) two members of the public;
2.25(4) two members who are registered nurses and represent greater Minnesota;
2.26(5) two members who are registered nurses and represent the metropolitan area;
2.27(6) two members who are registered nurses and represent hospitals licensed for
2.2825 beds or less; and
2.29(7) two members who are registered nurses and represent hospitals licensed for
2.30more than 25 beds.
2.31Costs incurred for staffing and managing this working group shall be paid for with hospital
2.32licensing fees.
2.33 Subd. 4. Assignment adjustments. (a) Hospitals must assign nursing personnel
2.34to each patient care unit consistent with nationally accepted nursing clinical standards.
2.35If a direct care registered nurse determines, based on the nurse's professional judgment,
2.36that adjustments in staffing levels are required due to patient acuity and nursing intensity,
3.1then shift-to-shift adjustments in staffing levels must be made according to procedures
3.2developed by the Safe Patient Assignment Committee, established pursuant to subdivision
3.35. Hospitals must not use mandatory overtime as a means to meet staffing standards.
3.4(b) A direct care registered nurse may not be disciplined for refusing to accept an
3.5assignment if, in good faith and in the nurse's professional judgment, the nurse determines
3.6that the assignment is unsafe for patients due to patient acuity and nursing intensity.
3.7 Subd. 5. Safe Patient Assignment Committee. (a) By July 1, 2014, every hospital
3.8licensed in the state must establish a Safe Patient Assignment Committee either by
3.9creating a new committee or assigning the functions of a staffing for patient safety
3.10committee to an existing committee.
3.11(b) Membership of the committee must include, but is not limited to, the following
3.12members:
3.13(1) at least 60 percent of the membership must be registered nurses who provide
3.14direct patient care; and
3.15(2) collective bargaining-appointed members to proportionately represent its nurses.
3.16Hospitals must compensate registered nurses who are employed by the hospital and serve on
3.17the staffing for Safe Patient Assignment Committee for time spent on committee business.
3.18(c) Safe Patient Assignment Committees shall:
3.19(1) complete a staffing for patient safety assessment by March 31, 2014, and
3.20annually thereafter that identifies the following:
3.21(i) problems of insufficient staffing including, but not limited to, inappropriate
3.22number of registered nurses scheduled in a unit, inappropriately experienced registered
3.23nurses scheduled for a particular unit, inability for nurse supervisors to adjust for increased
3.24acuity or activity in a unit, and chronically unfilled positions within the hospital;
3.25(ii) units that pose the highest risk to patient safety due to inadequate staffing; and
3.26(iii) solutions for problems identified under items (i) and (ii);
3.27(2) implement and evaluate staffing standards provided in subdivision 3;
3.28(3) convert national standards described in subdivision 3 into registered nurse hours
3.29of care per patient;
3.30(4) recommend a mechanism for tracking and analyzing staffing trends within the
3.31hospital;
3.32(5) develop a procedure for making shift-to-shift adjustments in staffing levels when
3.33such adjustments are required by patient acuity and nursing intensity; and
3.34(6) identify any incidents when the hospital has failed to meet the standards provided
3.35in subdivision 3 and recommend a remedy.
4.1 Subd. 6. Posting staffing levels. (a) Staffing levels for each unit must be
4.2conspicuously posted in each unit and in waiting areas. The postings must be visible
4.3to hospital staff, patients, and the public.
4.4(b) The commissioner must post on the Department of Health's Web site the
4.5standards for each unit as defined under subdivision 3.
4.6 Subd. 7. Reporting. Hospitals must publicly report hours-per-patient direct care
4.7that registered nurses spend per patient on all patient care units. The first report is due
4.8March 31, 2014, and quarterly thereafter. The report must include actual hours worked by
4.9registered nurses per patient, not scheduled hours. This report must be submitted to the
4.10commissioner and posted on the hospital's Web site and on the Department of Health's
4.11Web site. This report must be titled the "Real Time RN Staffing Report." Beginning
4.12March 31, 2015, hospitals must publicly report patient outcomes relative to actual hours
4.13worked by registered nurses per patient.
4.14 Subd. 8. Enforcement. The commissioner may sanction a hospital for failure to
4.15comply with the provisions of this section, including failure to staff patient care units
4.16at required levels.
