HB 0269 2004
   
1 A bill to be entitled
2          An act relating to nursing services; creating s. 395.0085,
3    F.S.; requiring hospitals to have organized nursing
4    services; providing definitions; requiring the appointment
5    of a chief nursing officer; providing qualifications for
6    chief nursing officers; providing an exception for certain
7    hospitals; providing responsibilities for chief nursing
8    officers; providing quality care standards; requiring the
9    appointment of a staffing committee by each hospital;
10    providing for membership; providing responsibilities of
11    the staffing committee; requiring the development and
12    adoption of plans and procedures concerning nursing staff;
13    providing for required components of the plans; requiring
14    annual evaluation of hospital staffing plans; requiring
15    hospitals to maintain a list of qualified, on-call nursing
16    staff and nursing services; prohibiting nursing personnel
17    from leaving certain patient care assignments; authorizing
18    the Agency for Health Care Administration to establish by
19    rule fines for violations of the act; requiring the Agency
20    for Health Care Administration to maintain for public
21    inspection a record of such fines; requiring the Agency
22    for Health Care Administration to conduct audits;
23    requiring the agency to prepare an annual report;
24    providing an effective date.
25         
26          Be It Enacted by the Legislature of the State of Florida:
27         
28          Section 1. Section 395.0085, Florida Statutes, is created
29    to read:
30          395.0085 Standards for nursing services.--Hospitals
31    licensed under this chapter shall have an organized nursing
32    service that provides 24-hour nursing services. The nursing
33    service shall have a plan of administrative authority and
34    delineation of responsibilities for patient care in all patient
35    care units.
36          (1) As used in this section, the term:
37          (a) "Mandatory overtime" means being required to work,
38    other than on-call time, when not scheduled, including beyond
39    hours or days scheduled. Neither the length of the shift nor the
40    number of shifts scheduled to work is a determinative factor in
41    defining mandatory overtime.
42          (b) "Nursing personnel” means registered nurses, licensed
43    practical nurses, and other personnel providing nursing care to
44    a hospital’s patients.
45          (c) "Nursing services" means an organized department with
46    the accountability and authority for practice areas responsible
47    for the delivery of services provided by nursing personnel to
48    patients.
49          (2) Nursing services shall be administered by the chief
50    nursing officer, who shall be a registered nurse and comply with
51    one of the following:
52          (a) Possess a master’s degree in nursing administration or
53    a clinical nursing specialty.
54          (b) Possess a master’s degree in health care
55    administration, public administration, or business
56    administration.
57          (c) Possess a master’s degree in a health-related field
58    obtained through a curriculum that included courses in
59    administration and management.
60          (d) File a written plan with the chief executive officer
61    of the hospital that presents evidence that the chief nursing
62    officer is actively working toward one of the degrees listed in
63    paragraphs (a)-(c). The evidence must also include courses
64    related to leadership, administration, management, performance
65    improvement, and theoretical approaches to delivering nursing
66    care.
67          (3) The chief nursing officer in statutory rural
68    hospitals, as defined in s. 395.602, or in hospitals that have
69    been certified by the Centers for Medicare and Medicaid Services
70    as critical access hospitals in accordance with 42 C.F.R. s.
71    485.606 shall be exempt from the requirements of subsection (2).
72          (4)(a) The chief nursing officer shall be responsible for
73    overseeing a hospital's delivery of nursing services, including
74    determining the types and numbers of nursing personnel and staff
75    necessary to provide safe, quality nursing in the hospital.
76          (b) The chief nursing officer shall report directly to the
77    chief executive officer of the hospital, who is responsible for
78    the daily operation of the hospital.
79          (c) The chief nursing officer shall participate with
80    leadership from the governing body, medical staff, and clinical
81    areas in planning, promoting, and conducting performance
82    improvement activities.
83          (5)(a) Under the supervision of the chief nursing officer,
84    a hospital shall adopt and implement policies and procedures to
85    ensure that each patient receives quality nursing services.
86          (b) Each hospital shall ensure that:
87          1. Adequate numbers of nursing personnel, including
88    registered nurses, are available on all patient care units at
89    all times.
90          2. There is sufficient supervisory and nursing personnel
91    for each department or nursing unit to provide, when needed, the
92    immediate availability of registered nurses for bedside care of
93    any patient.
94          3. There exists a pool of qualified, on-call nursing
95    personnel who may be contacted to provide replacement nursing
96    services in the event of sickness, vacations, vacancies, and
97    other absences of nursing personnel.
98          4. All licensed nursing personnel have valid and current
99    licenses.
100          (c) Under the supervision of the chief nursing officer, a
101    hospital shall be responsible for the development and
102    implementation of a written hospital-wide staffing plan for
103    nursing services designed to ensure quality nursing services.
104    The staffing plan must establish the minimum number of nursing
105    personnel necessary to provide quality nursing services. At a
106    minimum, the following factors shall be considered in the
107    determination of the staffing plan:
108          1. The number and type of patients for whom care is being
109    provided and unit characteristics, such as the number of
110    admissions, discharges, and transfers for each patient care
111    unit.
112          2. The medical characteristics of patients, the intensity
113    of patient care being provided, and the variability of patient
114    care across a nursing unit.
115          3. The scope of services provided.
116          4. The context within which care is provided, including
117    architecture and geography of the environment and the
118    availability of technology.
119          5. Nursing personnel characteristics, including staff
120    consistency and tenure, educational preparation and experience,
121    and the number and competencies of clinical and nonclinical
122    support staff the nurse must collaborate with or supervise.
123         
124          The hospital, under the supervision of the chief nursing
125    officer, shall adopt and implement procedures by which the
126    staffing plan for nursing services is developed. The procedures
127    shall include:
128          1. Establishing presumptive or initial staffing levels
129    that are recalculated as necessary, but no less often than
130    annually.
131          2. Setting staffing levels on a unit-by-unit basis or
132    other basis appropriate to the hospital.
133          3. Adjusting of nursing personnel staffing levels from
134    shift to shift based on factors such as the intensity of patient
135    care.
136          4. Reporting to the committee, as established under
137    subsection (6), the explanation for the variance. The reports
138    shall be confidential and not subject to disclosure, discovery,
139    subpoena, or other means of legal compulsion for their release.
140          (6)(a) The chief nursing officer shall appoint a staffing
141    committee to assist in the development of the staffing plan
142    required by paragraph (5)(c). The committee shall include:
143          1. As at least one-third of its membership, members who
144    are registered nurses who provide direct patient care at least
145    50 percent of their work time.
146          2. At least one registered nurse from either infection
147    control, quality assurance, or risk management.
148          3. To the extent feasible, nurses representing multiple
149    disciplines of nursing practice.
150          (b) The committee shall receive and review input from
151    nursing personnel on the development, the on-going monitoring,
152    and the evaluation of the staffing plan.
153          (c) The reports, records, and review materials received or
154    developed pursuant to paragraph (b) are confidential and not
155    subject to disclosure, discovery, subpoena, or other means of
156    legal compulsion for their release.
157          (7) The staffing plan required by paragraph (5)(c) shall:
158          (a) Be consistent with standards established by the
159    nursing profession and be developed based upon a review of the
160    codes of ethics developed by the nursing profession through
161    national nursing organizations.
162          (b) Utilize outcomes and nursing-sensitive indicators as
163    an integral role in setting and evaluating the adequacy of the
164    staffing plan. At least one from each of the following three
165    types of outcomes shall be correlated to the adequacy of
166    staffing:
167          1. Patient falls, adverse drug events, injuries to
168    patients, skin breakdown, pneumonia, infection rates, upper
169    gastrointestinal bleeding, shock, cardiac arrest, length of
170    stay, and patient readmissions.
171    2. Operational outcomes, such as work-related injury or
172    illness, vacancy and turnover rates, nursing care hours per
173    patient day, on-call use, and overtime rates.
174          3. Validated patient complaints related to staffing.
175          (c) Incorporate a process that facilitates the timely and
176    effective identification of concerns about the adequacy of the
177    staffing plan by the staffing committee established under
178    subsection (6). This process must include:
179          1. A prohibition of retaliation for reporting concerns.
180          2. A requirement that nursing personnel report concerns
181    timely through appropriate channels within the hospital.
182          3. Orientation of nursing personnel relating to the
183    reporting of concerns and to whom such reports should be made.
184          4. Opportunities for nursing personnel to provide feedback
185    during the staffing committee meetings as to how concerns are
186    addressed by the staffing committee established under subsection
187    (6).
188          5. Policies and procedures that require:
189          a. Orientation of nursing personnel to all units to which
190    they are assigned on either a temporary or permanent basis.
191          b. Documentation in accordance with hospital policy of the
192    orientation of nursing personnel and of their competency to
193    perform nursing services.
194          c. Nursing assignments to be congruent with documented
195    competency.
196          d. Mandatory overtime. When utilized as a means for
197    meeting staffing needs, policy and procedures for mandatory
198    overtime must be included. Policy and procedures for mandatory
199    overtime shall include:
200          (I) Documentation of the basis and justification for
201    mandatory overtime.
202          (II) An action plan for the reduction or elimination of
203    the use of mandatory overtime to meet staffing needs.
204          (III) A process for monitoring and evaluating the use of
205    mandatory overtime.
206          (IV) Procedures for notifying nurses and other nursing
207    care personnel of mandatory overtime policy.
208          (8) Each hospital shall conduct an evaluation of its nurse
209    staffing plan at least once each year. The evaluation must be in
210    writing and must include an assessment of the outcomes and
211    nursing-sensitive indicators as set forth in paragraph (7)(b).
212    The evaluation shall be documented in minutes of the staffing
213    committee established under subsection (6). Hospitals may
214    determine whether this evaluation is done on a unit-level or a
215    facility-level basis.
216          (9) Nonemployee licensed nurses who are working in the
217    hospital shall adhere to the policies and procedures of the
218    hospital. The chief nursing officer is responsible for the
219    adequate orientation, supervision, and evaluation of the
220    clinical activities of nonemployee nursing personnel which occur
221    within the responsibility of the nursing services.
222          (10) Nursing personnel at a hospital may not place a
223    patient at risk of harm by leaving a patient care assignment
224    during an agreed-upon shift or an agreed-upon extended shift
225    without authorization from the appropriate supervisory
226    personnel.
227          (11)(a) The agency may adopt rules to establish
228    administrative penalties, including a schedule of such
229    penalties, pursuant to s. 395.1055 for a violation of this
230    section.
231          (b) The agency shall maintain for public inspection
232    records of any penalties imposed on hospitals under this
233    section.
234          (c) The agency shall conduct an annual random audit during
235    regular or complaint-initiated hospital inspections of not less
236    that 7 percent of all hospitals in this state, excluding
237    hospitals awarded Magnet Status by the American Nurses
238    Credentialing Center, to verify compliance with the requirements
239    of this section.
240          (d) The agency shall prepare an annual report of the
241    audits conducted under this subsection.
242          Section 2. This act shall take effect upon becoming a law.