ASSEMBLY, No. 0 STATE OF NEW JERSEY th LEGISLATURE INTRODUCED JUNE, 0 Sponsored by: Assemblyman JOHN S. WISNIEWSKI District (Middlesex) SYNOPSIS Establishes minimum direct care registered professional nurse staffing ratios for hospitals and ambulatory surgical facilities. CURRENT VERSION OF TEXT As introduced.
A0 WISNIEWSKI 0 0 0 0 AN ACT concerning direct care registered professional nurse staffing ratios and supplementing Title of the Revised Statutes. BE IT ENACTED by the Senate and General Assembly of the State of New Jersey:. The Legislature finds and declares that: a. The State has an interest in promoting quality health care and improving the delivery of nursing care to patients in health care facilities in the State. b. Recent changes in health care and society have resulted in higher acuity levels among patients, increasing the need for measures that improve and protect patient care and reduce the incidence of errors. c. Nurse staffing practices that result in insufficient numbers of qualified, experienced registered nurses to care for the patient population jeopardize the delivery of quality health care and pose a danger to patients. d. Research has shown that patient outcomes are correlated with direct care registered nurse staffing levels. e. The establishment of minimum direct care registered nurse staffing ratios protects patient safety and improves the retention of registered nurses who might otherwise consider leaving the profession due to the stresses and demands created by inadequate staffing.. a. The Commissioner of Health shall adopt regulations that require general and special hospitals and ambulatory surgical facilities to implement minimum direct care registered professional nurse-to-patient staffing ratios in accordance with the requirements of this act. The regulations adopted pursuant to this section shall require that at all times during each shift within a unit of the hospital or ambulatory surgical facility and with a full complement of ancillary and support staff, one direct care registered professional nurse shall not be assigned to more than the following number of patients: () one patient in trauma emergency units; () one patient in operating room units, provided that at least one additional person serves as a scrub assistant in such unit; () two patients in critical care units, including neonatal intensive care units, emergency critical care and intensive care units, labor and delivery units, coronary care units, acute respiratory care units, post anesthesia units, and burn units; () three patients in emergency room units, pediatrics units, stepdown units, telemetry units, antepartum units, and combined labor, delivery, and postpartum units;
A0 WISNIEWSKI 0 0 0 0 () four patients in medical-surgical units, intermediate care nursery units, acute care psychiatric units, and other specialty care units; () five patients in rehabilitation units and skilled nursing units; and () six patients in postpartum units and well-baby nursery units. b. The Commissioner may apply the minimum direct care registered professional nurse-to-patient ratios established pursuant to subsection a. to a type of hospital unit not referred to in subjection a. if such type of hospital unit provides a level of care to patients whose needs are similar to the needs of patients cared for in the hospital units referred to in subsection a. of this section. c. The Department of Health shall monitor and enforce the minimum direct care registered professional nurse-to-patient staffing ratios required by this act through periodic inspections and audits of the staffing plans to be submitted to the Commissioner. d. For purposes of determining compliance with the regulations adopted pursuant to this act: () a patient assignment may be included in the calculation of the minimum direct care registered professional nurse-to-patient ratio only if the provision of care to the particular patient is within that direct care registered professional nurse s competence; () a hospital or ambulatory surgical facility shall not assign a direct care registered professional nurse to a unit unless the hospital or ambulatory surgical facility determines that the direct care registered professional nurse has demonstrated current competence in providing care in that unit and has received orientation to that unit sufficient to provide competent care to patients in that unit; () a hospital or ambulatory surgical facility shall not assign a direct care registered professional nurse from a temporary nursing agency to any unit unless such direct care registered professional nurse has demonstrated competence on the assigned unit and has received orientation to that hospital s or ambulatory surgical facility s unit sufficient to provide competent care for patients in that unit; () a hospital or ambulatory surgical facility shall not average the number of patients and the total number of direct care registered professional nurses assigned to patients in a hospital or ambulatory surgical facility during any shift or over any period of time; and () a hospital or ambulatory surgical facility shall not employ video monitors or any form of electronic visualization of a patient as a substitute for the direct observation required for patient assessment by the direct care registered professional nurse or as is required for patient safety and protection. e. As used in this act, direct care registered professional nurse means a registered professional nurse who provides bedside care for one or more patients.
A0 WISNIEWSKI 0 0 0 0. a. The Commissioner of Health shall require all general and special hospitals and ambulatory surgical facilities to develop, no later than months following enactment of P.L., c. (C. ) (pending before the Legislature as this bill), a staffing plan, to be approved by the Commissioner, and implemented no later than months following the enactment of P.L., c. (C. )(pending before the Legislature as this bill) to provide for direct care registered professional nurse-to-patient ratios above the minimum direct care registered professional nurse-to-patient ratios required under section of this act, if appropriate, based upon consideration of, but not limited to, the following factors: () the number of patients on a particular unit on a shift-by-shift basis; () the acuity level and nursing care plan of patients on a particular unit on a shift-by-shift basis; () the anticipated admissions, discharges, and transfers of patients during each shift that impacts direct patient care; () specialized experience required of direct care registered professional nurses on a particular unit; () staffing levels and services provided by licensed practical or vocational nurses or other ancillary staff in meeting direct patient care needs not required to be performed by a direct care registered professional nurse; and () obstacles to efficiency in the delivery of patient care presented by physical layout. b. A hospital or ambulatory surgical facility shall annually reevaluate its staffing plan in each unit in light of actual patient care requirements, and shall update the plan as appropriate. The staffing plan shall be developed and annually reevaluated on the basis of input from direct care registered professional nurses at the hospital from each unit or area, and if applicable, with the input of the collective bargaining representative of the direct care registered professional nurses at the hospital.. This act shall take effect on the first day of the sixth month next following the date of enactment, but the Commissioner of Health may take such anticipatory administrative action in advance as shall be necessary for the implementation of this act. STATEMENT This bill provides that the Commissioner of Health adopt regulations that require general and special hospitals and ambulatory surgical facilities to implement minimum direct care registered professional nurse-to-patient staffing ratios. Direct care registered professional nurse is defined by the bill as a registered
A0 WISNIEWSKI 0 0 0 0 professional nurse who provides bedside care for one or more patients. The regulations are to require that one direct care registered professional nurse shall not be assigned to more than the following number of patients: () one patient in trauma emergency units; () one patient in operating room units, provided that at least one additional person serves as a scrub assistant in such unit; ()two patients in critical care units, including neonatal intensive care units, emergency critical care and intensive care units, labor and delivery units, coronary care units, acute respiratory care units, post anesthesia units, and burn units; () three patients in emergency room units, pediatrics units, stepdown units, telemetry units, antepartum units, and combined labor, delivery, and postpartum units; () four patients in medical-surgical units, intermediate care nursery units, acute care psychiatric units, and other specialty care units; () five patients in rehabilitation units and skilled nursing units; and () six patients in postpartum units and well-baby nursery units. The bill provides that the Department of Health monitor and enforce the minimum direct care registered professional nurse-topatient staffing ratios required by this act through periodic inspections and audits of the staffing plans to be submitted to the Commissioner. The bill requires that all general and special hospitals and ambulatory surgical facilities develop, no later than months following enactment of this bill, a staffing plan, to be approved by the Commissioner, and implemented no later than months following enactment of the bill, to provide for registered professional nurse-to-patient ratios above the minimum ratios required by the bill, if appropriate, based upon consideration of, but not limited to, factors, such as: the number of patients on a particular unit on a shift-by-shift basis; the acuity level and nursing care plan of patients on a particular unit on a shift-by-shift basis; the anticipated admissions, discharges, and transfers of patients during each shift that impacts direct patient care; specialized experience required of direct care registered professional nurses on a particular unit; staffing levels and services provided by licensed practical or vocational nurses or other ancillary staff in meeting direct patient care needs not required to be performed by a direct care registered professional nurse; and obstacles to efficiency in the delivery of patient care presented by physical layout. The bill requires that hospitals and ambulatory surgical facilities annually reevaluate their staffing plan in light of actual patient care requirements, and update the plan as appropriate. The staffing plan is to be developed and annually reevaluated on the basis of input from direct care registered professional nurses at the hospital or
A0 WISNIEWSKI ambulatory surgical facility from each unit or area, and if applicable, with the input of the collective bargaining representative of the direct care registered professional nurses at the hospital or ambulatory surgical facility.