HB298: HB298 Health; requirements for nurse staffing in hospitals; provide

26 LC 46 1495S The House Committee on Health offers the following substitute to HB 298: A BILL TO BE ENTITLED AN ACT To amend Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to1 regulation and construction of hospitals and other health care facilities, so as to provide2 requirements for nurse and ancillary personnel staffing in hosp itals; to provide for3 definitions; to require a written nurse services staffing plan that includes ancillary personnel;4 to provide for the establishment of nurse staffing committees; to provide for annual reports5 of staffing information to the Department of Community Health; to provide for anonymous6 reports and investigations of unsafe staffing conditions; to establish an advisory commission;7 to provide for related matters; to repeal conflicting laws; and for other purposes.8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9 SECTION 1.10 Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to regulation and11 construction of hospitals and other health care facilities, is amended by revising Article 2,12 which is reserved, as follows:13 H. B. 298 (SUB) - 1 - 26 LC 46 1495S "ARTICLE 214 31-7-24.15 Reserved.16 31-7-30.17 As used in this article, the term:18 (1) 'Ancillary personnel' means unlicensed hospital staff who support the diagnosis,19 treatment, or care of a patient.20 (2) 'Hospital' means a hospital which is permitted to operate by the department pursuant21 to Article 1 of this chapter, including a hospital maintained o r operated by a hospital22 authority; provided, however, that this shall not include a sta t e o w n e d o r o p e r a t e d23 hospital.24 (3) 'Nurse services staffing plan' means the written staffing plan required to be25 established by a hospital pursuant to Code Section 31-7-31.26 (4) 'Nurse staffing committee' or 'committee' means the standing committee established27 by a hospital pursuant to Code Section 31-7-32.28 (5) 'Patient care unit' means a hospital's emergency departmen t and any unit or29 department of a hospital in which registered nurses provide dir ect patient care to30 inpatients.31 31-7-31.32 (a) The governing body of a hospital shall adopt and implement a written nurse services33 staffing plan to provide that an adequate number and skill mix of nurses and ancillary34 personnel consistent with the guidelines of the hospital's accrediting entity are available. 35 Such plan shall include a process for:36 H. B. 298 (SUB) - 2 - 26 LC 46 1495S (1) Requiring the hospital to give significant consideration to the nurse services staffing37 plan recommended by the hospital's nurse staffing committee and to that committee's38 evaluation of any existing plan;39 (2) Adopting and im plementing a nurse services staffing plan t hat is based on an40 assessment of the needs of each patient care unit and shift, in cluding evidence relating41 to patient care needs of each patient care unit at the hospital;42 (3) Considering the nurse services staffing plan as a component in setting the nurse and43 ancillary hospital staffing budget;44 (4) Encouraging nurses and ancillary personnel to provide inpu t to the committee45 relating to nurse and ancillary personnel staffing concerns, respectively;46 (5) Protecting nurses and ancillary personnel who provide input to the committee from47 retaliation; and48 (6) Monitoring compliance with any rules and regulations adopt ed by the department49 relating to nurse and ancillary personnel staffing.50 (b) The nurse services staffing plan adopted pursuant to subsection (a) of this Code section51 shall:52 (1) Consider the nurse and ancillary personnel staffing standards established by the Joint53 Commission or other nationally recognized accreditation organiz ations, by the54 department, or by nationally recognized hospital associations;55 (2) Set minimum staffing levels for patient care units:56 (A) Based on multiple nurse and ancillary personnel training and experience and other57 administrative considerations, as well as, patient considerations; and58 (B) Determined by the nursing assessment and in accordance with evidence based safe59 nursing standards;60 (3) Include a method for periodically adjusting the nurse services staffing plan for each61 patient care unit to address significant changes in utilization or other circumstances that62 H. B. 298 (SUB) - 3 - 26 LC 46 1495S impact nurse and ancillary personnel staffing and require staff ing flexibility to meet63 patient needs; and64 (4) Include a contingency plan when patient care needs unexpec tedly exceed direct65 patient care staff resources.66 (c) A hospital shall:67 (1) Consider the nurse services staffing plan:68 (A) As a component in setting the nurse and ancillary personnel staffing budget; and69 (B) To guide the hospital in assigning nurses and ancillary pe rsonnel to patient care70 units; and71 (2) Make readily available to nurses and ancillary personnel on each patient care unit at72 the beginning of each shift the nurse and ancillary personnel services staffing plan levels73 and current staffing levels for that unit and that shift.74 31-7-32.75 (a) A hospital shall establish a nurse staffing committee as a standing committee of the76 hospital.77 (b) The committee shall be composed of members who are representative of the types of78 nursing services provided in the hospital's patient care units.79 (c) The chief nursing officer of the hospital shall be a voting member of the committee.80 (d) At least 75 percent of the members of the committee shall be registered nurses who:81 (1) Provide direct patient care during at least 50 percent of their work time; and82 (2) Represent different patient care units provided by the hospital.83 (e) The committee shall meet at least quarterly.84 (f) The committee shall:85 (1) Develop and recommend to the hospital's governing body a nurse services staffing86 plan that meets the requirements of Code Section 31-7-31;87 (2) Review, assess, and respond to staffing concerns expressed to the committee;88 H. B. 298 (SUB) - 4 - 26 LC 46 1495S (3) Identify the nurse and ancillary personnel-sensitive outcome measures the committee89 will use to evaluate the effectiveness of the nurse services st affing plan for the patient90 care units;91 (4) Evaluate, at least semiannually, the effectiveness of the nurse services staffing plan,92 including the reasons for any significant variations between th e plan and the actual93 staffing; and94 (5) Submit to the hospital's governing body, at least semiannually, a report on nurse and95 ancillary personnel staffing and outcomes on the nurse and ancillary personnel-sensitive96 outcome measures reviewed by the committee, including the committee's evaluation of97 the effectiveness of the nurse services staffing plan and aggregate variations between the98 nurse services staffing plan and actual staffing.99 (g) In evaluating the effectiveness of the nurse services staffing plan, the committee shall100 consider, but is not limited to considering, patient needs, wor kforce shortages and101 availability, the nurse and ancillary personnel-sensitive outcome measures reviewed by the102 committee, any nurse and ancillary personnel satisfaction measu res collected by the103 hospital for the patient care units, and any nationally recognized, written, evidence based104 nurse staffing benchmarks.105 (h) All proceedings, records, and reports of the committee sha ll be deemed confidential106 review organization records under Code Section 31-7-133 and sha ll not be subject to107 Article 4 of Chapter 18 of Title 50, relating to inspection of public records. The nurse108 staffing plan adopted by a hospital shall not be subject to dis covery or introduction into109 evidence in any civil action; and no person who was in attendan ce at the proceeding of110 such committee shall be permitted or required to testify in any such civil action as to any111 evidence or other matters produced or presented during the proceedings or activities of the112 committee or as to the findings, recommendations, evaluations, opinions, or other actions113 of such committee or any members thereof. Information, documents, or records otherwise114 available from original sources, however, are not to be constru ed as immune from115 H. B. 298 (SUB) - 5 - 26 LC 46 1495S discovery or use in any such civil action merely because they w ere presented during116 proceedings of such committee or contained in the hospital's nurse services staffing plan;117 nor should any person who participates in the committee's proceedings or who is a member118 of such committee be prevented from testifying as to matters wi thin such person's119 knowledge, but such witness cannot be asked about such witness' s discussions during120 committee proceedings or about opinions formed by such witness as a result of committee121 proceedings. Notwithstanding the foregoing, the Department of Community Health may122 inspect and copy committee records and the nurse services staff ing plan when it is123 determined by the department to be necessary in the performance of the department's124 licensure and certification responsibilities under Code Section 31-7-15; provided, however,125 that such inspection and copying shall not waive or abrogate th e confidentiality of such126 committee materials.127 31-7-33.128 (a) A hospital shall annually report to the department, and the department shall include as129 a confidential addendum to the annual hospital questionnaire, the following information:130 (1) Whether the hospital's governing body has adopted a nurse services staffing plan as131 required by Code Section 31-7-31;132 (2) Whether the hospital has established a nurse staffing committee as required by Code133 Section 31-7-32 that meets the membership requirements of such Code section;134 (3) Whether the nurse staffing committee has evaluated the hos pital's nurse services135 staffing plan as required by Code Section 31-7-32 and has repor ted the results of the136 evaluation to the hospital's governing body as provided by such Code section; and137 (4) The nurse and ancillary personnel-sensitive outcome measur e s t h e c o m m i t t e e138 adopted for use in evaluating the hospital's nurse services staffing plan.139 H. B. 298 (SUB) - 6 - 26 LC 46 1495S (b) To the extent possible, the department shall collect the information required pursuant140 to subsection (a) of this Code section in conjunction with surveys or other data required to141 be submitted to the department under other laws or regulations.142 (c) The reports provided by the hospitals under subsection (a) of this Code section shall143 not be subject to Article 4 of Chapter 18 of Title 50, relating to inspection of public144 records.145 31-7-34.146 (a) The department shall maintain a secure online portal for t he submission by hospital147 staff members of anonymous reports of unsafe staffing conditions in any hospital patient148 care unit, provided that the forms for reporting shall require specificity, including the149 patient care unit; the date, time, and description of the conditions deemed unsafe; and any150 supporting information.151 (b) Upon receipt of a report that complies with subsection (a) of this Code section, the152 department shall forward such report to its Healthcare Facility Regulation Division for153 possible investigation and to the nurse staffing committee of the hospital that is the subject154 of the report.155 (c) If the Healthcare Facility Regulation Division determines that a patient care unit156 identified in a report made under subsection (a) of this Code section failed to comply with157 nurse staffing requirements established by the department or violated any rule or regulation158 relating to the licensing of hospitals on the date identified i n the complaint or during an159 on-site investigation, the Healthcare Facility Regulation Divis ion is authorized to take160 appropriate actions under the provisions of Code Section 31-2-8.161 (d) The reports provided by hospital staff members under subse ction (a) of this Code162 section shall not be subject to Article 4 of Chapter 18 of Title 50, relating to inspection of163 public records.164 H. B. 298 (SUB) - 7 - 26 LC 46 1495S 31-7-35.165 (a) There is hereby established an advisory commission, compos ed of 12 members as166 follows:167 (1) The following members appointed by the Governor:168 (A) An expert in nursing practice, quality of nursing care, or patient care standards;169 (B) A representative of an association representing nurses; and170 (C) Two representatives of an association representing hospitals;171 (2) The following members appointed by the President of the Senate:172 (A) An expert in nursing practice, quality of nursing care, or patient care standards;173 (B) A registered nurse who provides direct patient care at a hospital at least 50 percent174 of the work time; and175 (C) Two representatives of a hospital in a rural county; and176 (3) The following members appointed by the Speaker of the House of Representatives:177 (A) An expert in nursing practice, quality of nursing care, or patient care standards;178 (B) A representative of an association representing nurses; and179 (C) Two representatives of a hospital.180 (b) The members of the advisory commission shall serve at the pleasure of the appointing181 official. Members of the advisory commission shall keep confid ential any information182 received in the course of their duties and shall only use such information in the course of183 carrying out their duties on the advisory commission, except those reports required to be184 issued by the commission under this Code section, which shall only include de-identified185 information that cannot reasonably be used to identify any person, hospital, or other entity.186 (c) The advisory commission shall convene annually in order to evaluate the effectiveness187 of the nurse staffing committees established pursuant to Code S ection 31-7-32. Such188 review shall evaluate quantitative and qualitative data, includ ing, but not limited to,189 whether staffing levels were improved and maintained, patient s atisfaction, employee190 H. B. 298 (SUB) - 8 - 26 LC 46 1495S satisfaction, patient quality of care metrics, workplace safety , and any other metrics the191 advisory commission deems relevant.192 (d) The advisory commission may collect and shall be provided all relevant information193 necessary to carry out its functions from the department and ot her appropriate state194 agencies. The commission may also invite testimony by experts in the field and from the195 public. In making its recommendations pursuant to subsection (e) of this Code section, the196 advisory commission shall analyze relevant data provided by the department or other state197 agencies, including data and factors contained in subsection (a) of Code Section 31-7-31198 related to nurse services staffing plans. The advisory commiss ion may also make199 recommendations for additional or enhanced enforcement mechanis ms or powers to200 address hospital failure to comply with this article and recomm end the appropriation of201 funds for the department to enforce this article or to assist hospitals in recruiting or hiring202 additional nursing staff.203 (e) The advisory commission shall submit to the Speaker of the House of Representatives,204 the President of the Senate, and the chairpersons of the House Committee on Health and205 Senate Health and Human Services Committee, and make available to the public, a report206 that may include recommendations for further legislative action, if any, in order to improve207 nurse staffing in hospitals pursuant to the intent of this article.208 (f) Any information collected pursuant to Code Section 31-7-33 and provided to the209 advisory commission shall not be subject to Article 4 of Chapter 18 of Title 50, relating to210 inspection of public records."211 SECTION 2.212 All laws and parts of laws in conflict with this Act are repealed.213 H. B. 298 (SUB) - 9 -