HB 298: Health; requirements for nurse staffing in hospitals; provide

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 to regulation and construction of hospitals and other health care facilities, so as to provide requirements for nurse and ancillary personnel staffing in hospitals; to provide for definitions; to require a written nurse services staffing plan that includes ancillary personnel; to provide for the establishment of nurse staffing committees; to provide for annual reports of staffing information to the Department of Community Health; to provide for anonymous reports and investigations of unsafe staffing conditions; to establish an advisory commission; to provide for related matters; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to regulation and construction of hospitals and other health care facilities, is amended by revising Article 2, which is reserved, as follows:

"ARTICLE 2

31-7-24.

Reserved.

31-7-30.

As used in this article, the term:

(1) 'Ancillary personnel' means unlicensed hospital staff who support the diagnosis, treatment, or care of a patient.

(2) 'Hospital' means a hospital which is permitted to operate by the department pursuant to Article 1 of this chapter, including a hospital maintained or operated by a hospital authority; provided, however, that this shall not include a state owned or operated hospital.

(3) 'Nurse services staffing plan' means the written staffing plan required to be established by a hospital pursuant to Code Section 31-7-31.

(4) 'Nurse staffing committee' or 'committee' means the standing committee established by a hospital pursuant to Code Section 31-7-32.

(5) 'Patient care unit' means a hospital's emergency department and any unit or department of a hospital in which registered nurses provide direct patient care to inpatients.

31-7-31.

(a) The governing body of a hospital shall adopt and implement a written nurse services staffing plan to provide that an adequate number and skill mix of nurses and ancillary personnel consistent with the guidelines of the hospital's accrediting entity are available. Such plan shall include a process for:

(1) Requiring the hospital to give significant consideration to the nurse services staffing plan recommended by the hospital's nurse staffing committee and to that committee's evaluation of any existing plan;

(2) Adopting and implementing a nurse services staffing plan that is based on an assessment of the needs of each patient care unit and shift, including evidence relating to patient care needs of each patient care unit at the hospital;

(3) Considering the nurse services staffing plan as a component in setting the nurse and ancillary hospital staffing budget;

(4) Encouraging nurses and ancillary personnel to provide input to the committee relating to nurse and ancillary personnel staffing concerns, respectively;

(5) Protecting nurses and ancillary personnel who provide input to the committee from retaliation; and

(6) Monitoring compliance with any rules and regulations adopted by the department relating to nurse and ancillary personnel staffing.

(b) The nurse services staffing plan adopted pursuant to subsection (a) of this Code section shall:

(1) Consider the nurse and ancillary personnel staffing standards established by the Joint Commission or other nationally recognized accreditation organizations, by the department, or by nationally recognized hospital associations;

(2) Set minimum staffing levels for patient care units:

(A) Based on multiple nurse and ancillary personnel training and experience and other administrative considerations, as well as, patient considerations; and

(B) Determined by the nursing assessment and in accordance with evidence based safe nursing standards;

(3) Include a method for periodically adjusting the nurse services staffing plan for each patient care unit to address significant changes in utilization or other circumstances that impact nurse and ancillary personnel staffing and require staffing flexibility to meet patient needs; and

(4) Include a contingency plan when patient care needs unexpectedly exceed direct patient care staff resources.

(c) A hospital shall:

(1) Consider the nurse services staffing plan:

(A) As a component in setting the nurse and ancillary personnel staffing budget; and

(B) To guide the hospital in assigning nurses and ancillary personnel to patient care units; and

(2) Make readily available to nurses and ancillary personnel on each patient care unit at the beginning of each shift the nurse and ancillary personnel services staffing plan levels and current staffing levels for that unit and that shift.

31-7-32.

(a) A hospital shall establish a nurse staffing committee as a standing committee of the hospital.

(b) The committee shall be composed of members who are representative of the types of nursing services provided in the hospital's patient care units.

(c) The chief nursing officer of the hospital shall be a voting member of the committee.

(d) At least 75 percent of the members of the committee shall be registered nurses who:

(1) Provide direct patient care during at least 50 percent of their work time; and

(2) Represent different patient care units provided by the hospital.

(e) The committee shall meet at least quarterly.

(f) The committee shall:

(1) Develop and recommend to the hospital's governing body a nurse services staffing plan that meets the requirements of Code Section 31-7-31;

(2) Review, assess, and respond to staffing concerns expressed to the committee;

(3) Identify the nurse and ancillary personnel-sensitive outcome measures the committee will use to evaluate the effectiveness of the nurse services staffing plan for the patient care units;

(4) Evaluate, at least semiannually, the effectiveness of the nurse services staffing plan, including the reasons for any significant variations between the plan and the actual staffing; and

(5) Submit to the hospital's governing body, at least semiannually, a report on nurse and ancillary personnel staffing and outcomes on the nurse and ancillary personnel-sensitive outcome measures reviewed by the committee, including the committee's evaluation of the effectiveness of the nurse services staffing plan and aggregate variations between the nurse services staffing plan and actual staffing.

(g) In evaluating the effectiveness of the nurse services staffing plan, the committee shall consider, but is not limited to considering, patient needs, workforce shortages and availability, the nurse and ancillary personnel-sensitive outcome measures reviewed by the committee, any nurse and ancillary personnel satisfaction measures collected by the hospital for the patient care units, and any nationally recognized, written, evidence based nurse staffing benchmarks.

(h) All proceedings, records, and reports of the committee shall be deemed confidential review organization records under Code Section 31-7-133 and shall not be subject to Article 4 of Chapter 18 of Title 50, relating to inspection of public records. The nurse staffing plan adopted by a hospital shall not be subject to discovery or introduction into evidence in any civil action; and no person who was in attendance at the proceeding of such committee shall be permitted or required to testify in any such civil action as to any evidence or other matters produced or presented during the proceedings or activities of the committee or as to the findings, recommendations, evaluations, opinions, or other actions of such committee or any members thereof. Information, documents, or records otherwise available from original sources, however, are not to be construed as immune from discovery or use in any such civil action merely because they were presented during proceedings of such committee or contained in the hospital's nurse services staffing plan; nor should any person who participates in the committee's proceedings or who is a member of such committee be prevented from testifying as to matters within such person's knowledge, but such witness cannot be asked about such witness's discussions during committee proceedings or about opinions formed by such witness as a result of committee proceedings. Notwithstanding the foregoing, the Department of Community Health may inspect and copy committee records and the nurse services staffing plan when it is determined by the department to be necessary in the performance of the department's licensure and certification responsibilities under Code Section 31-7-15; provided, however, that such inspection and copying shall not waive or abrogate the confidentiality of such committee materials.

31-7-33.

(a) A hospital shall annually report to the department, and the department shall include as a confidential addendum to the annual hospital questionnaire, the following information:

(1) Whether the hospital's governing body has adopted a nurse services staffing plan as required by Code Section 31-7-31;

(2) Whether the hospital has established a nurse staffing committee as required by Code Section 31-7-32 that meets the membership requirements of such Code section;

(3) Whether the nurse staffing committee has evaluated the hospital's nurse services staffing plan as required by Code Section 31-7-32 and has reported the results of the evaluation to the hospital's governing body as provided by such Code section; and

(4) The nurse and ancillary personnel-sensitive outcome measures the committee adopted for use in evaluating the hospital's nurse services staffing plan.

(b) To the extent possible, the department shall collect the information required pursuant to subsection (a) of this Code section in conjunction with surveys or other data required to be submitted to the department under other laws or regulations.

(c) The reports provided by the hospitals under subsection (a) of this Code section shall not be subject to Article 4 of Chapter 18 of Title 50, relating to inspection of public records.

31-7-34.

(a) The department shall maintain a secure online portal for the submission by hospital staff members of anonymous reports of unsafe staffing conditions in any hospital patient care unit, provided that the forms for reporting shall require specificity, including the patient care unit; the date, time, and description of the conditions deemed unsafe; and any supporting information.

(b) Upon receipt of a report that complies with subsection (a) of this Code section, the department shall forward such report to its Healthcare Facility Regulation Division for possible investigation and to the nurse staffing committee of the hospital that is the subject of the report.

(c) If the Healthcare Facility Regulation Division determines that a patient care unit identified in a report made under subsection (a) of this Code section failed to comply with nurse staffing requirements established by the department or violated any rule or regulation relating to the licensing of hospitals on the date identified in the complaint or during an on-site investigation, the Healthcare Facility Regulation Division is authorized to take appropriate actions under the provisions of Code Section 31-2-8.

(d) The reports provided by hospital staff members under subsection (a) of this Code section shall not be subject to Article 4 of Chapter 18 of Title 50, relating to inspection of public records.

31-7-35.

(a) There is hereby established an advisory commission, composed of 12 members as follows:

(1) The following members appointed by the Governor:

(A) An expert in nursing practice, quality of nursing care, or patient care standards;

(B) A representative of an association representing nurses; and

(C) Two representatives of an association representing hospitals;

(2) The following members appointed by the President of the Senate:

(A) An expert in nursing practice, quality of nursing care, or patient care standards;

(B) A registered nurse who provides direct patient care at a hospital at least 50 percent of the work time; and

(C) Two representatives of a hospital in a rural county; and

(3) The following members appointed by the Speaker of the House of Representatives:

(A) An expert in nursing practice, quality of nursing care, or patient care standards;

(B) A representative of an association representing nurses; and

(C) Two representatives of a hospital.

(b) The members of the advisory commission shall serve at the pleasure of the appointing official. Members of the advisory commission shall keep confidential any information received in the course of their duties and shall only use such information in the course of carrying out their duties on the advisory commission, except those reports required to be issued by the commission under this Code section, which shall only include de-identified information that cannot reasonably be used to identify any person, hospital, or other entity.

(c) The advisory commission shall convene annually in order to evaluate the effectiveness of the nurse staffing committees established pursuant to Code Section 31-7-32. Such review shall evaluate quantitative and qualitative data, including, but not limited to, whether staffing levels were improved and maintained, patient satisfaction, employee satisfaction, patient quality of care metrics, workplace safety, and any other metrics the advisory commission deems relevant.

(d) The advisory commission may collect and shall be provided all relevant information necessary to carry out its functions from the department and other appropriate state agencies. The commission may also invite testimony by experts in the field and from the public. In making its recommendations pursuant to subsection (e) of this Code section, the advisory commission shall analyze relevant data provided by the department or other state agencies, including data and factors contained in subsection (a) of Code Section 31-7-31 related to nurse services staffing plans. The advisory commission may also make recommendations for additional or enhanced enforcement mechanisms or powers to address hospital failure to comply with this article and recommend the appropriation of funds for the department to enforce this article or to assist hospitals in recruiting or hiring additional nursing staff.

(e) The advisory commission shall submit to the Speaker of the House of Representatives, the President of the Senate, and the chairpersons of the House Committee on Health and Senate Health and Human Services Committee, and make available to the public, a report that may include recommendations for further legislative action, if any, in order to improve nurse staffing in hospitals pursuant to the intent of this article.

(f) Any information collected pursuant to Code Section 31-7-33 and provided to the advisory commission shall not be subject to Article 4 of Chapter 18 of Title 50, relating to inspection of public records."

SECTION 2.

All laws and parts of laws in conflict with this Act are repealed.